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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/mA 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.

INTRODUCTION AND OBJECTIVES: In the United States, renal access for percutaneous nephrolithotomy (PCNL) is most commonly performed using fluoroscopic guidance. Fluoroscopy provides good structural visualization of the collecting system but requires the use of ionizing radiation. Ultrasonography (US) is an alternative imaging modality for achieving percutaneous renal access and provides both collecting system and visceral imaging compared to fluoroscopy. The purpose of this study is to compare radiation exposure and surgical outcomes for PCNL between cases performed with USversus fluoroscopy-guided renal access. METHODS: This prospective cohort study enrolled 118 PCNL cases from the UCSF hospital system between May 2014 and May 2015, of which 48 were performed with fluoroscopic guidance (group 1) and 70 with US guidance (group 2) for percutaneous renal access. USguided cases were those for which US was utilized for all or the majority of renal access, while fluoroscopy-guided cases were those done purely using fluoroscopy. The main variables measured included radiation dose, total operative time, residual stone status, serum creatinine change, hematocrit change, perioperative transfusion rate, surgical complication rate (Clavien class >2), and hospital length of stay. RESULTS: Groups 1 and 2 were comparable, having mean ages of 53.9 13.8 vs. 54.2 12.2, percent male patients of 43.8% vs. 41.4%, mean BMI of 30.9 8.1 vs. 29.3 9.8, and mean ASA physical status classification of 2.1 0.6 vs. 2.3 0.7, respectively. Patients in group 2 received less total mean radiation dose (18.5 mGy vs. 46.0 mGy, P