Can Color Doppler Ultrasound Challenge the Paradigm in Percutaneous Nephrolithotomy?

Objectives: Compare color Doppler (Color) ultrasound-guided puncture with common type-B (Type-B) ultrasound-guided puncture in reducing the incidence of hemorrhagic complications of percutaneous nephrolithotomy (PCNL). Materials and Methods: A total of 348 patients who received PCNL from September 2017 to December 2018 were divided into Color (231 cases) and Type-B groups (117 cases). The avascular area of the target fornix was pinpointed in the Color group, whereas the middle of the target fornix was the default puncture point in the Type-B group. Tract bleeding, nephrostomy tract creation time, operation time, postoperative hemoglobin (Hb) values and serum creatine (Scr) concentrations, and stone-free rates were analyzed. Results: Color Doppler imaging revealed that 35.1% of the cases in the Color group (81/231) had variable artery positioning in the target fornix. Tract bleeding and postoperative Hb reduction in the Color group were significantly lower than the Type-B group (10.8% vs 24.8%, p = 0.0007, and 4.87 ± 8.58 g/L vs 7.70 ± 8.90 g/L, p = 0.0044, respectively). The postoperative hospitalization of the Color group was also shortened (8.3 ± 5.9 days vs 9.7 ± 3.0 days, p < 0.0001). Although working channel creation took longer in this group (4.2 ± 0.3 minutes vs 3.6 ± 0.2 minutes, p < 0.0001), there were no significant differences in the total operation time between the two groups (39.2 ± 15.2 minutes vs 36.4 ± 16.5 minutes, p = 0.1097) or postoperative Scr and stone-free rates. Conclusion: Vascular variation of the fornix is very common. Consistent puncture of the avascular area of the target fornix significantly lowered tract bleeding and postoperative Hb decrease compared with traditional procedures. Color Doppler ultrasound-guided puncture is, thus, useful to reduce the incidence of severe hemorrhagic complications of PCNL.