Fluoroscopy Methods in Supine PCNL: Impact on Radiation and Surgical Outcomes

Overview

This study compared intermittent versus continuous (live) fluoroscopy during supine percutaneous nephrolithotomy (PCNL) to evaluate differences in radiation exposure and surgical outcomes. Intermittent fluoroscopy significantly reduced fluoroscopy time without compromising operative time, stone-free rates, or complication rates.

Background

Nephrolithiasis is increasingly prevalent worldwide, with PCNL recommended as the primary treatment for kidney stones larger than 2 cm. Fluoroscopy is the most commonly used imaging modality during PCNL but exposes patients and surgical teams to ionizing radiation. Reducing fluoroscopy time is a practical approach to minimize radiation exposure. This study investigates the effects of intermittent (one-spot) versus continuous fluoroscopy on radiation dose and surgical results in supine PCNL.

Data Highlights

Key Findings

• Intermittent fluoroscopy significantly reduces fluoroscopy time during supine PCNL compared to continuous fluoroscopy.
• No significant difference in operative time between intermittent and continuous fluoroscopy groups.
• Stone-free rates were similar regardless of fluoroscopy method used.
• Postoperative complication rates did not differ significantly between groups.
• Intermittent fluoroscopy uses single-shot imaging during critical steps, minimizing radiation exposure.
• Both fluoroscopy methods were performed by experienced surgeons under standardized protocols.

Clinical Implications

Adopting intermittent fluoroscopy during supine PCNL can effectively reduce radiation exposure to patients and surgical teams without negatively impacting surgical efficiency or outcomes. Surgeons should consider intermittent fluoroscopy as a practical radiation-sparing technique during PCNL procedures.

Conclusion

Intermittent fluoroscopy is a safe and effective method to reduce radiation exposure in supine PCNL, maintaining comparable surgical results to continuous fluoroscopy. This approach supports radiation safety without compromising patient care.

References

1. European Association of Urology Guidelines 2023 -- Management of Kidney Stones
2. American Urological Association Guidelines 2023 -- Surgical Treatment of Nephrolithiasis
3. Study Authors 2025 -- Effects of Fluoroscopy Methods on Radiation Exposure and Surgical Results in Supine PCNL