Department of Urology, University of California-San Francisco, California.
Department of Urology, University of California-San Francisco, California; Division of Urology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
J Urol. 2017 Dec;198(6):1367-1373. doi: 10.1016/j.juro.2017.07.074. Epub 2017 Jul 23.
We compared contrast enhanced ultrasound and fluoroscopic nephrostography in the evaluation of ureteral patency following percutaneous nephrolithotomy.
This prospective cohort, noninferiority study was performed after obtaining institutional review board approval. We enrolled eligible patients with kidney and proximal ureteral stones who underwent percutaneous nephrolithotomy at our center. On postoperative day 1 patients received contrast enhanced ultrasound and fluoroscopic nephrostogram within 2 hours of each other to evaluate ureteral patency, which was the primary outcome of this study.
A total of 92 pairs of imaging studies were performed in 82 patients during the study period. Five study pairs were excluded due to technical errors that prevented imaging interpretation. Females slightly predominated over males with a mean ± SD age of 50.5 ± 15.9 years and a mean body mass index of 29.6 ± 8.6 kg/m. Of the remaining 87 sets of studies 69 (79.3%) demonstrated concordant findings regarding ureteral patency for the 2 imaging techniques and 18 (20.7%) were discordant. The nephrostomy tube was removed on the same day in 15 of the 17 patients who demonstrated antegrade urine flow only on contrast enhanced ultrasound and they had no subsequent adverse events. No adverse events were noted related to ultrasound contrast injection. While contrast enhanced ultrasound used no ionizing radiation, fluoroscopic nephrostograms provided a mean radiation exposure dose of 2.8 ± 3.7 mGy.
A contrast enhanced ultrasound nephrostogram can be safely performed to evaluate for ureteral patency following percutaneous nephrolithotomy. This imaging technique was mostly concordant with fluoroscopic findings. Most discordance was likely attributable to the higher sensitivity for patency of contrast enhanced ultrasound compared to fluoroscopy.
我们比较了对比增强超声和透视性肾盂造影在经皮肾镜取石术后评估输尿管通畅性中的作用。
本前瞻性队列非劣效性研究在获得机构审查委员会批准后进行。我们纳入了在我院接受经皮肾镜取石术的肾结石和近端输尿管结石患者。术后第 1 天，患者在 2 小时内分别接受对比增强超声和透视性肾盂造影，以评估输尿管通畅性，这是本研究的主要结局。
在研究期间，82 例患者共进行了 92 对影像学检查。由于技术错误导致影像学解释无法进行，排除了 5 对研究。女性略多于男性，平均年龄±标准差为 50.5±15.9 岁，平均体重指数为 29.6±8.6kg/m。在剩余的 87 对研究中，69 对（79.3%）两种影像学技术的输尿管通畅性检查结果一致，18 对（20.7%）结果不一致。在仅通过对比增强超声显示顺行尿液流动的 17 例患者中，有 15 例在当天拔除了肾造瘘管，他们没有发生后续不良事件。超声造影剂注射未引起不良反应。虽然对比增强超声不使用电离辐射，但透视性肾盂造影的平均辐射剂量为 2.8±3.7mGy。
对比增强超声肾造瘘术可安全用于评估经皮肾镜取石术后输尿管通畅性。该影像学技术与透视性肾盂造影结果大多一致。大多数不一致可能归因于对比增强超声对通畅性的敏感性高于透视性肾盂造影。
