Totally ultrasonography-guided percutaneous nephrolithotomy in the flank position

Purpose: To present totally ultrasonography-guided percutaneous nephrolithotomy (PCNL) in the flank position, its preliminary results, and the practical considerations. Patients and Methods: From January 2007 until July 2007, a total of 30 candidates for PCNL (22 men and 8 women), with a mean age of 40.69 +/- 13.9 years (range 18-65 yrs), were included in this study. We eliminated radiography, and both access to the collecting system and tract dilation were performed under ultrasonographic guidance. The patients were placed in the standard flank position. Results: Twenty-five (83.3%) patients had complete stone clearance. The stone-free rate was 88.9% in the patients with a single calculus (18 cases), and it was 75.0% in the patients with staghorn or multiple calculi (12 cases). There was no major complication intraoperatively or postoperatively. The mean operative time was 68.75 +/- 34.48 minutes (range 30-150 min). The mean hospitalization time was 3.8 +/- 1.15 days (range 3-7 d). Conclusion: Totally ultrasonography-guided PCNL has satisfactory outcomes compared with the standard technique of PCNL, without any major complications and with the advantage of preventing radiation hazards and damage to the adjacent organs. Furthermore, using this technique, anesthesia is more tolerable in the flank position.