Clinical Scorecard: Effects of Fluoroscopy Methods on Radiation Exposure and Surgical Results in Supine Percutaneous Nephrolithotomy

At a Glance

Key Highlights

• Intermittent fluoroscopy uses single-shot imaging during critical steps to reduce fluoroscopy time and radiation exposure compared to continuous (live) fluoroscopy.
• Fluoroscopy time is a key surrogate marker for radiation dose and occupational exposure during PCNL.
• Supine PCNL with intermittent fluoroscopy maintains operative outcomes including stone-free rates and complication profiles.

Guideline-Based Recommendations

Diagnosis

• Use non-contrast abdominal CT with stone protocol preoperatively to assess stone location and size.
• Ensure negative urine culture and appropriate antibiotic prophylaxis before surgery.

Management

• Perform PCNL in supine position with fluoroscopy-guided renal access.
• Use intermittent fluoroscopy (single-shot imaging) during puncture and tract dilation to reduce radiation exposure.
• Place Double-J ureteral stent antegrade after stone removal.

Monitoring & Follow-up

• Monitor fluoroscopy time as a surrogate for radiation exposure during the procedure.
• Perform routine laboratory tests including renal function before and one hour after surgery.
• Assess stone-free status postoperatively by absence of debris or fragments smaller than 3 mm.

Risks

• Radiation exposure is linearly related to fluoroscopy duration and poses risks to patients and surgical staff.
• Cumulative radiation exposure is particularly critical for healthcare professionals.
• Exclude patients with solitary kidney, renal anomalies, or elevated creatinine to reduce procedural risks.

Patient & Prescribing Data

392 patients undergoing supine PCNL after applying exclusion criteria

Intermittent fluoroscopy reduces fluoroscopy time and radiation exposure without compromising surgical outcomes compared to continuous fluoroscopy.

Clinical Best Practices

• Use intermittent fluoroscopy with single-shot imaging during critical steps to minimize radiation exposure.
• Position patient in Galdakao-modified Valdivia supine position for PCNL.
• Use radiopaque markers and C-arm angulation (0° and 30° cranial tilt) to accurately determine puncture needle depth and calyx targeting.
• Employ appropriate dilation techniques (Amplatz or balloon) guided by intermittent fluoroscopy.
• Ensure preoperative negative urine culture and administer antibiotic prophylaxis.
• Define stone-free status as absence of fragments >3 mm postoperatively.

References

• European Association of Urology (EAU) Guidelines on Urolithiasis
• American Urological Association (AUA) Guidelines on Management of Kidney Stones
• Radiation Exposure and Reduction Strategies in PCNL