Objective: The objective of this study is to compare the outcome of planning supine percutaneous nephrolithotomy (PCNL) using images obtained from multi-slice computed tomography (CTU) and intravenous urography (IVU).
Patients and Methods: This study was completed on 60 patients with renal stone disease from March 2011 to October 2012 in the Urology Department, Benha University Hospital, Benha, Egypt. All the patients were treated by supine PCNL. They were divided randomly into two groups, group I included 30 patients, PCNL access was planned based on IVU, group II included 30 patients, PCNL access was planned based on multi-slice CTU. All patients were suitable for PCNL based on findings at X ray KUB and ultrasonograpgy of KUB. The patients had body mass index (BMI) below 30. Exclusion criteria were renal anomalies and bleeding diathesis. Data from both groups regarding mean time taken to gain percutaneous access, operative time, fluoroscopic time, access difficulty, stone free rate and intraoperative morbidity were collected and compared between the groups.
Results: The mean time taken to gain percutaneous access was longer in group I (22.2±1.76) compared to group II (13.1±1.62) patients (p < 0.001). The operative time was longer in group I (81.9±14.9) compared to group II (58.8±7.6) (p < 0.001). Fluoroscopic time was longer in group I (3.5±1.7) compared to group II (2.2±1.3) (p= 0.002). There were 4 cases (13.3%) in group I where we had difficulty in establishing percutaneous access, while there was no case in group II (p = 0.003). Intra-operative morbidity (significant bleeding requiring blood transfusion), occurred in 3 cases (10 %) for group I and 2 cases (6.7%) for group II. There were no other significant complications in both groups.
Conclusion: These data show that multislice CT is a safer, more reliable, more accurate and non- invasive imaging technique than IVU in mapping the pelvicalyceal system (PCS) and complex renal calculi and is essential in choosing the optimal percutaneous access into the PCS for safer and more successful PCNL.