Comparative Study of Blind Dilation versus Dilation Under Fluoroscopic Guidance in Percutaneous Nephrolithotomy Surgery

Abstract

Introduction Percutaneous nephrolithotomy (PCNL) has turned to one of the major therapeutic approaches for renal stones. PCNL under fluoroscopic guidance is the most common modality applied to access the pyelocaliceal system. The purpose of this article is to compare the results of blind and fluoroscopy-guided dilation in PCNL candidates. Methods Over 20-year-old individuals with either over 2 centimeters pelvic/pyelocalis renal stone(s) or over 1 centimeter compact renal stone in the proximal of ureter confirmed in ultrasonography or computed tomography (CT) scan were included. Renal anomalies or single kidney, uncontrolled coagulopathy, previous history of PCNL, pregnancy, active urinary tract infection, full staghorn renal stone and serum creatinine level above 1.5 mg/dl were considered as the exclusion criteria. The study population was gathered through convenience sampling. Then, they were randomly assigned into either blind or fluoroscopy-guided dilatation groups using Random Allocation Software. accordingly, each patient was given a number by the software, if the number was odd the patient was allocated to the blind group, otherwise, he/she entered into the flouroscopy-guided PCNL group. Results In the present article, data of 96 patients undergoing PCNL in two groups of blind versus fluoroscopy-guided Dilatation were evaluated. The studied patients had the mean age of 49.57±12.15 years old and predominantly consisted of males (57.3). The assessed groups were similar in terms of age (P-value=0.544), gender distribution (P-value=0.536), and body mass index (P-value=0.210). Besides, the stone-related characteristics including the largest renal stone diameter (P-value=0.403), the location of the stones (P-value>0.05) and the targeted calyx (P-value>0.05) did not differ between the study groups. Conclusions According to findings of the present research, despite the similar success rate, stone residual fragments and complications of both blind versus fluoroscopy-guided dilatation, the remarkable longer duration of irradiation fluoroscopic modality convinced us that blind technique might be superior. © 2025 Urology Research Center (URC), Tehran University of Medical Sciences.