Ultrasound-guided percutaneous nephrolithotomy (PCNL) is a well-established procedure for managing kidney stones, particularly in cases of solitary kidney stones. The procedure boasts high stone-free rates but carries risks of bleeding complications, especially in solitary kidney patients due to physiological changes in the kidney. These changes can lead to increased risks of intraoperative hemorrhage and postoperative deterioration of renal function.
While previous studies have explored the application of PCNL in solitary kidney cases, the use of Doppler ultrasound technology in this context remains underexplored. Doppler ultrasound, integrated into ultrasound systems, allows real-time visualization of renal blood flow distribution, aiding surgeons in identifying vascular-rich regions within the kidney parenchyma for optimal puncture sites during PCNL.
Researchers conducted a retrospective comparative analysis of 76 patients with solitary kidney stones who underwent ultrasound-guided PCNL. Patients were divided into two groups based on the use of Doppler flow detection technology during the procedure. The study aimed to evaluate the role of Doppler ultrasound in reducing hemorrhagic events during PCNL in solitary kidney stones.
The results showed that while the puncture time was longer in the Doppler-assisted group, there were no significant differences in hemoglobin loss, operation duration, transfusion rates, postoperative creatinine levels, overall complications, or stone-free rates between the two groups. Both groups demonstrated similar safety profiles, with low rates of major complications.
Ultrasound-guided PCNL has gained popularity for its advantages, such as zero radiation exposure and real-time imaging. However, challenges remain, including the steep learning curve and limited vascular discrimination with conventional ultrasound. Doppler ultrasound offers the potential to address these challenges by providing real-time blood flow visualization and aiding in the avoidance of vascular-rich regions during renal puncture.
While this study did not find significant benefits of Doppler ultrasound in reducing hemorrhagic complications during PCNL for solitary kidney stones, it highlighted the importance of expertise in ultrasound-guided procedures. The findings suggest that while Doppler ultrasound may be a valuable training tool, its routine use may not be necessary in experienced hands.
Overall, the study contributes to the understanding of the role of Doppler ultrasound in PCNL for solitary kidney stones and underscores the importance of further research to optimize the use of imaging technologies in urological procedures.
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