L. Sanchez

V63 Large upper-calyx stone: Can supra-twelfth PCNL approach be avoided?

as duplicated systems and compound calyxes can be navigated with confidence. Radiography assisted navigation can augment visual navigation compromised by blood or debris. During percutaneous nephrolitotomy (PCNL), roadmapping allows more precise placement of the dilation balloon. CONCLUSIONS: This novel application of fluoroscopy can be applied whenever a pyelogram would be helpful. With additional experience and optimization of the technical aspects this can provide another tool for complex endourologic procedures. Future research will be needed to quantify the benefits in regards to operative success, operative time, and radiation exposure.

1528 ULTRASONOGRAPHY GUIDED PCNL: THE LEARNING CURVE OF A NOVEL TECHNIQUE

INTRODUCTION AND OBJECTIVES: PCNL is the endourological procedure that requires the higher extent of fluoroscopy time. Fully ultrasonography guided PCNL is an option to reduce radiation exposure. Some steps of the technique could be complex to handle at the beginning, especially tract dilation. We assessed the transition from an experienced pure-fluoroscopic PCNL surgeon, with familiarity in ultrasound scanning, to a totally ultrasonography PCNL practitioner in selected cases. METHODS: Thirty three patients, with at least some degree of pyelocalyceal system dilation underwent fully ultrasonography guided percutaneous nephrolithotomies (FUGPN) from March 2011 to June 2012. All the patients were operated by the same surgeon. Renal units were approached in prone position, after placement of an open end ureteral catheter for saline instillation. An ultrasound scanning was performed to guide puncture and for tract dilation monitoring. This last step was achieved with a 24 Fr balloon dilator, to limit passages of dilation devices through renal parenquima. We compared perioperative outcomes of the first 20 patients who underwent this procedure with the last 13 patients. Demographic and clinical data, puncture time (PT) and tract dilation time (TDT), as well as overall surgical time (ST) were recorded. Stone free rate, change in hemoglobin and hospital stay were also collected. RESULTS: The 2 groups had comparable preoperative demographics. All patients were successfully accessed and the procedures were completed. All patients were treated with single tracts. There were not major complications, transfusions or readmissions. Mean stone volume was 32 mm (range: 2.5 4.2) for the whole group. The mean ST for the first and second group was 70.57 and 58.75 minutes respectively (p 0.001). There was not a statistically significant difference in PT between the two groups. TDT for the first and second group was 15.04 and 10.11 minutes respectively (p 0.001). These figures show a downward trend in both ST and TDT during the evaluated period. Stone free rate for the first and second group was 90 and 100%. There were not any significant differences in change in hemoglobin and hospital stay for the two groups. CONCLUSIONS: An experienced endourological surgeon can make the transition from pure fluoroscopy PCNL cases to a totally ultrasonography approach relatively quickly. Tract dilation is the most demanding step to control, since deepness orientation needs to be developed with the first cases.