الفهرس 
Aim of workOnly 14 pages are availabe for public view
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Abstract
Percutaneous nephrolithotomy (PCNL) is the gold standard for large renal calculi. We aimed to compare the outcomes of two different puncture techniques; fluoroscopic (0-30º) versus the newly reported simplified (0-90º) technique.
We consented and randomized 90 patients undergoing PCNL for renal stones > 2cm, using unequal allocation (2:2:1:1) into four groups: group 1(prone 0-30), group 2 ( prone new modified 0-90), group 3(supine 0-30) and group 4(supine new modified 0-90) using random table envelope. We collected puncture success, number of attempts, puncture fluoroscopy screening time, and intraoperative complications.
Our results were the mean age was 46±13 years and BMI 26.7±4.3 kg/m2 with 53% males and insignificant difference regarding the rest of the demographic variables. The median number of puncture attempts was 1(IQR 12) times in groups 1 and 2 with an insignificant difference (p=0.5), while 2 (IQR 2- 3) in group 3 and 1(IQR 1-2) in group 4 with significant difference (p=0.003). The (0-90º) prone group 2 had greater mean fluoroscopy time (126.90 ± 57.07 Sec) & mean X-ray exposure dose (0.16±0.11 mSv) with significant p-value (p=0.03, p=0.0001) in comparison with group 1 Table (2). Meanwhile, group 4 had the lowest mean fluoroscopy time (56.40 ± 24.42) & X-ray exposure dose (0.03±0.02 mSv) with significant p-value (p=0.0001, p=0.0001) Table (5) in comparison with group 3.
No patient underwent blood transfusion in both groups with similar mean hemoglobin DROP across different groups (1.5±0.8 vs. 1.5±0.2 and 1.37±0.57 vs. 1.07 ± 0.54) with an insignificant difference too (p=0.9, p=0.15). We concluded that; both 0-30° and the simplified 0-90° have shown similar puncture success rates with similar puncture-related complications and stone-free rates. Simplified 0-90° showed a significant increase in fluoroscopy exposure time and X-ray dose in comparison to the 0-30° technique in a prone position, while it was superior in the supine one.