Fluoroscopy versus ultrasound for image guidance during percutaneous nephrolithotomy: a systematic review and meta-analysis

This meta-analysis aims to compare the safety and efficacy of fluoroscopy versus ultrasound guidance during the access to the renal collecting system. A systematic literature review was performed in September 2016. Outcomes were explored using review manager v5.0. 18 studies with 2919 patients were included in the final analysis. There was no significant difference in stone-free rate (RR: 1.0; 95% CI, 0.98 to 1.05; p = 0.41), operation time (MD: 1.75; 95% CI, -9.15 to 12.65; p = 0.75), hospital stay (MD: -1.02; 95% CI, -3.08 to 1.05; p = 0.34), and success rate of tract creation (RR: 1.00; 95% CI, 0.98-1.02; p = 0.88) between ultrasonography and fluoroscopy. Compared to fluoroscopy, ultrasonography had shorter puncture time (MD: -4.71; 95% CI, -6.43 to -3.0; p < 0.0001), higher success rate of fist puncture (RR: 1.16; 95% CI, 1.04 to 1.3; p = 0.01), less blood loss (MD: -0.42, 95% CI -0.81 to -0.02; p = 0.04), and less transfusion requirement (RR: 0.73; 95% CI, 0.33-1.6; p = 0.44). Two patients in each group experienced perforation of the renal pelvis. Five patients in fluoroscopy and two in ultrasonography group had pneumothorax. One patient in fluoroscopy group had intestinal injury. Both fluoroscopy and ultrasound guidance can aid to obtain successful percutaneous renal access. The advantages of ultrasonography over fluoroscopy include shorter puncture time, higher success rate of fist puncture, less blood loss, and less complications.