Kidney stone surgery can be a major ordeal. A new study looked at whether changing the angle of the ultrasound used to guide the procedure could make it easier on patients. The research compared two ultrasound techniques in 91 people undergoing surgery for complex kidney stones. The study found that the newer 'extraplanar' ultrasound approach was linked to operations that were about 37 minutes shorter and hospital stays that were two days shorter, on average. It was also associated with slightly lower levels of creatinine—a marker of kidney function—after surgery. Importantly, both techniques were equally good at clearing the stones. Four patients who had the newer technique developed a postoperative fever. It's crucial to understand this was a retrospective study, meaning researchers looked back at past records. The group that got the conventional technique started out with larger stones, which could have made their surgeries more difficult and influenced the results. Because of this, we can't say for sure that the new technique caused the better outcomes; we can only see an association.
Extraplanar ultrasound guidance for multi-tract PCNL linked to shorter operative time and hospital stayCould a different ultrasound angle make kidney stone surgery easier?
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A retrospective cohort study compared extraplanar ultrasound-guided multi-tract percutaneous nephrolithotomy (PCNL) to conventional ultrasound-guided multi-tract PCNL in 91 patients with complex renal stones. The conventional group had a significantly larger median maximum stone diameter (30 mm vs 22 mm, p=0.001), which the authors acknowledged as a potential confounder.
Despite this baseline imbalance, the extraplanar guidance group had a shorter median operative time (108 minutes vs 145 minutes, p=0.001) and a shorter median hospital stay (8 days vs 10 days, p=0.01). Postoperative serum creatinine levels were also lower in the extraplanar group (80 µmol/L vs 87 µmol/L, p=0.03). The stone-free rate showed no significant difference (57% for extraplanar vs 55% for conventional).
Regarding safety, postoperative fever was reported in 4 patients in the extraplanar group. Serious adverse events, discontinuations, and broader tolerability data were not reported. Key limitations include the retrospective design and the acknowledged baseline imbalance in stone size between groups, which limits causal inference. Funding and conflicts of interest were not reported.
For practice, this study suggests an association between the extraplanar ultrasound guidance technique and potentially improved perioperative metrics in this specific surgical context. However, clinicians should interpret these findings as preliminary associations from a non-randomized comparison with significant confounders. The lack of difference in the primary clinical endpoint (stone-free rate) and the short-term nature of the outcomes warrant restraint in changing practice based on this evidence alone.
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