JCU - January 2022 - 6

993729
URO
Journal of Clinical UrologyIrani et al.
Randomized Controlled Trial
Complications and surgical results of
stone-directed antegrade pyelography
compared to the retrograde pyelographic
access method in percutaneous
nephrolithotomy using 'bull's eye'
technique: A randomized clinical trial
Journal of Clinical Urology
2022, Vol. 15(1) 6 -12
© British Association of
Urological Surgeons 2021
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/2051415821993729
journals.sagepub.com/home/uro
https://doi.org/10.1177/2051415821993729
Dariush Irani1,2, Abdolreza Haghpanah1,2 , Mohammad Mehdi Hosseini1,2,
Leila Malekmakan2, Mohammad Ali Ashraf2,3 and
Hadi Raeisi Shahraki4
Abstract
Objectives: This study aimed to evaluate the differences in outcomes and complications in stone-directed antegrade
pyelography using the 'bull's eye' technique in patients with renal stones versus the conventional method of percutaneous
nephrolithotomy (PCNL). Although conventional PCNL access using retrograde pyelography is useful, it is time-consuming
and may cause postoperative discomfort. Herein, we report our experience in the application of this new technique.
Methods: Between January 2017 and June 2018, 100 patients participated in this randomized clinical trial. Stone-directed
antegrade pyelography using the 'bull's eye' technique under fluoroscopic guidance was used for percutaneous access in
the intervention group. The second group, consisting of those who had undergone conventional PCNL using retrograde
pyelography and 'bull's eye' technique in the same period, were considered as the controls. Pre- and postoperative
laboratory examinations, surgical results and complications were recorded and compared between the two groups.
Results: A single calyceal puncture in partial staghorn and staghorn stone patients was sufficient in 72.2% of the
antegrade group and in 78.9% of the retrograde group (p=0.69). The double-puncture technique was necessary for
71.9% of renal pelvis stones in the antegrade group and for 9.4% in the retrograde group (p<0.001). The antegrade
approach reduced the mean operative time and analgesic requirement significantly (p<0.001). No statistically significant
difference, however, was found between the two groups regarding stone migration to the ureter, radiation time and
postoperative complications.
Conclusions: The stone-directed antegrade approach using the 'bull's eye' technique is a safe and accurate method in
PCNL access in patients with radiopaque and semi-opaque renal stones.
Keywords
Stone-directed, antegrade access, PCNL
Date received: 10 September 2020; accepted: 7 January 2021
1 Division of Urology, Shiraz University of Medical Sciences, Shahid
Faghihi Medical Centre, Iran
2 Shiraz Nephro-Urology Research Centre, Shiraz University of Medical
Sciences, Iran
3 Student Research Committee, Shiraz University of Medical Sciences,
Iran
4 Department of Biostatistics, School of Medicine, Shiraz University of
Medical Sciences, Iran
Corresponding author:
Abdolreza Haghpanah, Endourology Ward, Urology Department,
Nephrology-Urology Research Centre, Shiraz University of Medical
Sciences, Zand Street, Shiraz, 71 32326645, Iran.
Email: ar.haghpanah2019@gmail.com
https://uk.sagepub.com/en-gb/journals-permissions https://www.doi.org/10.1177/2051415821993729 https://journals.sagepub.com/home/uro

JCU - January 2022

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