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Article

Endoscopic Verification of Transpapillary Access in Supine Percutaneous Nephrolithotomy: A Prospective Pilot Study Comparing Freehand Ultrasound and Fluoroscopy Guidance

by
Fatih Bicaklioglu
1,* and
Bilal Eryildirim
1,2
1
Department of Urology, Kartal Dr. Lutfi Kirdar City Hospital, 34865 Istanbul, Turkey
2
Department of Urology, University of Health Sciences, 34668 Istanbul, Turkey
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(15), 5604; https://doi.org/10.3390/jcm14155604 (registering DOI)
Submission received: 29 April 2025 / Revised: 16 June 2025 / Accepted: 6 August 2025 / Published: 7 August 2025
(This article belongs to the Special Issue New Challenges in Urolithiasis)

Abstract

Background/Objectives: Achieving renal access is a key step in percutaneous nephrolithotomy (PNL), with transpapillary access considered the safest anatomical approach. This prospective pilot study aimed to compare the effectiveness of freehand ultrasound-guided (F-UG) versus fluoroscopy-guided (FG) punctures in achieving anatomically accurate transpapillary access during supine PNL, confirmed by endoscopic visualization. Perioperative and postoperative outcomes were also evaluated. Methods: Forty-three patients undergoing supine PNL for renal pelvic or lower calyceal stones were prospectively enrolled and assigned to either the FG group (n = 23) or F-UG group (n = 20). Following renal access, intraoperative flexible ureteroscopy confirmed the anatomical nature of the puncture (transpapillary vs. nonpapillary). The puncture time, fluoroscopy time, operative time, complications (Clavien–Dindo classification), transfusion requirement, hospital stay, and one-month stone-free rates were recorded. Results: Transpapillary access was achieved in 95.7% of FG cases and 55.0% of F-UG cases (p = 0.003). Radiation exposure was significantly lower in the F-UG group (p < 0.001). Complication (15.0% vs. 0.0%) and transfusion rates (10.0% vs. 0.0%) were higher in the F-UG group but not statistically significant (p = 0.092 and p = 0.210, respectively). Other outcomes, including the operative time, hospital stay, and stone-free rates, were similar between groups. Conclusions: FG puncture is more effective for achieving transpapillary access, while F-UG significantly reduces radiation exposure. The endoscopic confirmation method may provide a reference for future comparative studies on access techniques in PNL.
Keywords: percutaneous nephrolithotomy; renal calculi; ultrasonography; fluoroscopy; transpapillary access; nonpapillary access; supine position; ureteroscopy; radiation exposure percutaneous nephrolithotomy; renal calculi; ultrasonography; fluoroscopy; transpapillary access; nonpapillary access; supine position; ureteroscopy; radiation exposure

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MDPI and ACS Style

Bicaklioglu, F.; Eryildirim, B. Endoscopic Verification of Transpapillary Access in Supine Percutaneous Nephrolithotomy: A Prospective Pilot Study Comparing Freehand Ultrasound and Fluoroscopy Guidance. J. Clin. Med. 2025, 14, 5604. https://doi.org/10.3390/jcm14155604

AMA Style

Bicaklioglu F, Eryildirim B. Endoscopic Verification of Transpapillary Access in Supine Percutaneous Nephrolithotomy: A Prospective Pilot Study Comparing Freehand Ultrasound and Fluoroscopy Guidance. Journal of Clinical Medicine. 2025; 14(15):5604. https://doi.org/10.3390/jcm14155604

Chicago/Turabian Style

Bicaklioglu, Fatih, and Bilal Eryildirim. 2025. "Endoscopic Verification of Transpapillary Access in Supine Percutaneous Nephrolithotomy: A Prospective Pilot Study Comparing Freehand Ultrasound and Fluoroscopy Guidance" Journal of Clinical Medicine 14, no. 15: 5604. https://doi.org/10.3390/jcm14155604

APA Style

Bicaklioglu, F., & Eryildirim, B. (2025). Endoscopic Verification of Transpapillary Access in Supine Percutaneous Nephrolithotomy: A Prospective Pilot Study Comparing Freehand Ultrasound and Fluoroscopy Guidance. Journal of Clinical Medicine, 14(15), 5604. https://doi.org/10.3390/jcm14155604

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