Document Detail

Reduced radiation exposure with the use of an air retrograde pyelogram during fluoroscopic access for percutaneous nephrolithotomy.
MedLine Citation:
PMID:  21426236     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Fluoroscopy with retrograde pyelogram is commonly used to obtain access for percutaneous nephrolithotomy (PNL). Our practice uses room air for retrograde identification of calyceal anatomy. Herein we explore whether an air pyelogram was associated with a decrease in radiation exposure compared with standard retrograde pyelogram.
METHODS: We retrospectively reviewed all PNL procedures performed at our institution over the past 2 years. Of the 260 PNL procedures performed during the study period, 96 had information on radiation dosage required for analysis. The effective dose (ED) was calculated using accepted conversion tables. Multivariable linear regression was used to determine the association between ED and the use of air pyelogram controlling for factors thought to affect radiation exposure.
RESULTS: Of the 96 PNL procedures included in the study, 60 (63%) were performed with an air retrograde pyelogram (AP) and 36 (37%) used contrast retrograde pyelogram (CP). Both groups were matched in terms of age, body mass index, stone burden, and number of access tracts. Multivariable linear regression showed significantly lower radiation exposure in the AP group than in the CP group (p = 0.001). There was no difference in fluoroscopy time between the two groups. Using an AP lowered the mean adjusted ED nearly twofold, from 7.67 (CI = 5.99-9.81) to 4.45 (CI = 3.68-5.38) mSv.
CONCLUSIONS: An air retrograde pyelogram is associated with decreased radiation exposure during PNL when compared with a contrast retrograde pyelogram.
Michael E Lipkin; John G Mancini; Dorit E Zilberman; Maria E Raymundo; Daniel Yong; Michael N Ferrandino; Michael J Miller; Terry T Yoshizumi; Glenn M Preminger
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Publication Detail:
Type:  Journal Article     Date:  2011-03-22
Journal Detail:
Title:  Journal of endourology / Endourological Society     Volume:  25     ISSN:  1557-900X     ISO Abbreviation:  J. Endourol.     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-04-08     Completed Date:  2011-07-21     Revised Date:  2012-02-08    
Medline Journal Info:
Nlm Unique ID:  8807503     Medline TA:  J Endourol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  563-7     Citation Subset:  IM    
Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
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MeSH Terms
Aged, 80 and over
Contrast Media / diagnostic use
Dose-Response Relationship, Radiation*
Fluoroscopy / methods*
Middle Aged
Nephrostomy, Percutaneous / methods*
Urography / methods*
Young Adult
Reg. No./Substance:
0/Contrast Media
Comment In:
J Endourol. 2012 Jan;26(1):73-4   [PMID:  21864027 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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