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• W2912649683 abstract "You have accessJournal of UrologyStone Disease: New Technology I1 Apr 2014PD36-06 DIRECT ENDOSCOPIC VISUALIZATION WITH COMBINED ULTRASOUND GUIDED ACCESS DURING PERCUTANEOUS NEPHROLITHOTOMY – A FEASIBILITY STUDY AND COMPARISON TO CONVENTIONAL COHORT Muhannad Alsyouf, Gaudencio Olgin, Roger Li, Michelle Lightfoot, Jason Smith, Evan Lehrman, Don C. Arnold, Javier Arenas, and D. Duane Baldwin Muhannad AlsyoufMuhannad Alsyouf More articles by this author , Gaudencio OlginGaudencio Olgin More articles by this author , Roger LiRoger Li More articles by this author , Michelle LightfootMichelle Lightfoot More articles by this author , Jason SmithJason Smith More articles by this author , Evan LehrmanEvan Lehrman More articles by this author , Don C. ArnoldDon C. Arnold More articles by this author , Javier ArenasJavier Arenas More articles by this author , and D. Duane BaldwinD. Duane Baldwin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2443AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Achieving access in PCNL remains a challenging procedure requiring significant radiation exposure to both patient and staff. In an attempt to reduce radiation exposure, we employed a novel technique combining direct ureteroscopic visualization of access location with ultrasound guidance. The purpose of this study is to compare outcomes in patients who underwent US guided percutaneous renal access to conventional fluoroscopic guided access. METHODS In this novel technique, a ureteroscope was placed in the kidney using a fluoroless technique. Under direct endoscopic vision the optimal calyx for access was selected. Percutaneous US guidance was used to advance a chiba needle into the desired calyx identified using deflection of the ureteroscope tip. A wire was then advanced into the calyx and grasped using a basket and pulled into the ureter. Balloon, sheath and nephrostomy tube placement were all performed under direct ureteroscopic guidance. Perioperative parameters of 10 consecutive patients undergoing this technique over a 6 month period were matched against 20 patients who had undergone conventional fluoroscopic access. Primary outcomes selected for comparison were total operative time, fluoroscopy time, EBL, stone free rates, hospital stay and complications. An independent samples Mann-Whitney U test and Pearson Chi-square test were used for comparisons, with p<0.05 considered statistically significant. RESULTS Using this novel technique, mean operative time was 217 minutes (162-322), mean fluoroscopy time needed to obtain access was 4.6 seconds (0 – 27.9), mean total fluoroscopic time was 10.6 seconds (0-47.1), mean EBL was 80ml, stone free rates was 80%, mean hospital stay was 3.2 days (1-5) and complication rate was 20% (both Clavien two). In comparing these 10 patients to 20 matched conventional PCNL patients, there was no difference in operative time (p=0.749), EBL (p=0.880), stone free rates (p=0.377), mean hospital stay (p=0.155) or complication rates (p=0.559). However, the novel technique resulted in significant reduction in fluoroscopy time to achieve access (4.6 vs.790 sec; p<0.001) and total fluoroscopy time (10.6 vs 859 sec; p<0.001) when compared to the conventional technique. CONCLUSIONS This study demonstrates the feasibility of combined US and ureteroscopic assisted access for PCNL including tract dilation and tube placement under direct endoscopic visualization. In addition, the study demonstrates a >90% reduction in fluoroscopy time using this technique. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e903 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Muhannad Alsyouf More articles by this author Gaudencio Olgin More articles by this author Roger Li More articles by this author Michelle Lightfoot More articles by this author Jason Smith More articles by this author Evan Lehrman More articles by this author Don C. Arnold More articles by this author Javier Arenas More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ..." @default.
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• W2912649683 title "PD36-06 DIRECT ENDOSCOPIC VISUALIZATION WITH COMBINED ULTRASOUND GUIDED ACCESS DURING PERCUTANEOUS NEPHROLITHOTOMY – A FEASIBILITY STUDY AND COMPARISON TO CONVENTIONAL COHORT" @default.
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