Abstract
PD35-10 RENAL TRACT DILATION IS A SIGNIFICANT SOURCE OF RADIATION EXPOSURE DURING PERCUTANEOUS NEPHROLITHOTOMY: RESULTS FROM THE REGISTRY FOR STONES OF THE KIDNEY AND URETER (RESKU)
The Journal of urology, Vol.199(4S), pp.e724-e725
04/2018
DOI: 10.1016/j.juro.2018.02.1721
Abstract
INTRODUCTION AND OBJECTIVES
Limiting the amount of ionizing radiation exposure for both patients and staff is an important principle in the management of patients with kidney stones. While ultrasound guided access during percutaneous nephrolithotomy (PCNL) has been shown to help reduce the amount of radiation associated with this operation, the radiation exposure associated with the remaining portions of this surgery is overlooked and to date has not been reported. This study aimed to quantify fluoroscopic radiation exposure during renal tract dilation for patients undergoing PCNL at a high-volume stone center.
METHODS
From October 2015 to October 2017, consecutive patients who underwent PCNL at the University of California San Francisco (UCSF) with two surgeons had total fluoroscopic time and cumulative radiation dose during PCNL recorded for this prospective cohort study. As part of the Registry for Stones of the Kidney and Ureter (ReSKU), intraoperative characteristics are recorded. Patients who underwent PCNL with only ultrasound (US) for renal tract access and dilation, US for renal tract access and fluoroscopy for dilation (US-FL), and fluoroscopy only (FL) for renal tract access and dilation were compared. Multivariate linear regression analysis was performed to examine factors associated with increased cumulative dosage.
RESULTS
A total of 243 patients underwent 274 PCNL operations during the study period. Of these, 152 were US, 74 FL, and 48 US-FL. There were no statistically significant differences in mean patient age, BMI, stone burden, or stone free rates across the 3 groups. While the US group received no radiation exposure, the FL and US-FL groups were exposed to means of 181.5 vs 88.4 seconds total fluoroscopy time and 41.8 vs 17.7 mGy cumulative radiation dose respectively (p<0.01). Multivariate linear regression revealed a statistically significant association of higher cumulative radiation dose with both BMI and operative time in all groups (p<0.01).
CONCLUSIONS
Nearly half of intraoperative radiation exposure during PCNL occurs during renal tract dilation compared to access. Adopting ultrasound or alternative approaches to fluoroscopy to guide tract dilation can have a significant impact on reducing total radiation exposure for patients and providers. Efforts to try and limit the amount of radiation exposure after gaining access during PCNL warrant further study.
Details
- Title: Subtitle
- PD35-10 RENAL TRACT DILATION IS A SIGNIFICANT SOURCE OF RADIATION EXPOSURE DURING PERCUTANEOUS NEPHROLITHOTOMY: RESULTS FROM THE REGISTRY FOR STONES OF THE KIDNEY AND URETER (RESKU)
- Creators
- David T. TzouManuel Armaz Villaneda - San Francisco, CASamuel ZetumerShalonda Reliford-TitusKazumi TaguchiManint UsawachintachitMarshall L. StollerThomas Chi
- Resource Type
- Abstract
- Publication Details
- The Journal of urology, Vol.199(4S), pp.e724-e725
- DOI
- 10.1016/j.juro.2018.02.1721
- ISSN
- 0022-5347
- eISSN
- 1527-3792
- Language
- English
- Date published
- 04/2018
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984697047202771
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