Clinical Application Of SonixGPS Ultrasound Navigation System Combined With Fiber Optic Ureteroscope In Percutaneous Nephrolithotomy

Objective:SonixGPS real-time guided ultrasound navigation system combined with fiber optic ureteroscope guided percutaneous nephrolithotripsy(PCNL)was applied,and compared with conventional ultrasound-guided PCNL,to explore the efficacy and safety of SonixGPS ultrasound navigation system combined with fiber optic ureteroscope guided percutaneous nephrolithotripsy,and to explore a safer and more effective percutaneous renal puncture technology.Methods:A prospective study was conducted on 95 patients with calculi who met the study requirements in our hospital from November 2019 to December 2020.Bilateral PCNL was performed in 5 of the 95 patients.Patients underwent a total of 100 PCNL operations.Patients were randomly divided into observation group:SonixGPS real-time guided ultrasound navigation system combined with fiber optic ureteroscope guided PCNL,Control group:Routine ultrasound-guided PCNL.The observation group included 30 males and 21 females.The average age was(51.3± 10.8)years from 28 to 77 years old.BMI was 16.5 to 33.3,with an average of(23.2±3.8);The calculi size measured by CT was 13.0±110.0mm,with an average of(40.3±23.6)mm.The non-enhanced CT values of calculi ranged from 363.1 to 1619.0Hu,with an average of(1011.3±286.5)Hu.CT measurements of hydronephrosis ranged from 13.0 to 105.0mm,with an average of(38.5±21.1)mm.There were 34 males and 15 females in the control group.The average age was(52.1± 11.5)years from 25 to 83 years old.BMI ranged from 17.1 to 29.0 with an average of(22.7±2.9).The calculi size measured by CT was 10.0-129.2mm,with an average of(38.1 ±24.8)mm.The non-enhanced CT values of calculi were 457.3～1488.5Hu,with an average of(997.6±216.7)Hu.CT measurements of hydronephrosis ranged from 12.0 to 87.0mm,with an average of(33.3 ± 17.4)mm.The number of percutaneous renal puncture,puncture time,operation time,postoperative blood routine changes,postoperative complications,postoperative hospital stay and stone clearance rate were observed in the two groups.Results:Single channel percutaneous nephrolithotripsy was successfully performed in both groups.The observation group was better than the control group in intraoperative puncture time,one-time puncture success rate,number of percutaneous renal puncture,hemoglobin decrease and RBC decrease(P<0.05).In the observation group,there was no prolapse of the guidewire from the percutaneous renal channel during the expansion of the channel,and no loss of the channel;the success rate of channel establishment was 100%.In the control group,the guidewire slipped out from the percutaneous renal channel when the channel was expanded in 2 patients,and 1 patient lost the channel;the channel loss rate was 2.0%.There was no blood transfusion in the observation group,while 3 patients in the control group needed blood transfusion after operation.There were no statistically significant differences between the two groups in surgical site,sliding out rate of guidewire during expansion passage,channel loss rate,WBC changes,operative time,postoperative hospital stay,postoperative fever(≥38.5℃),postoperative blood transfusion and stone clearance rate(P>0.05).In patients with mild hydronephrosis,the decrease of hemoglobin and puncture time in the observation group were less than those in the control group,and the difference was statistically significant(P<0.05);In the observation group,there was no prolapse of the guidewire from the percutaneous renal channel during the expansion of the channel,and no loss of the channel;the success rate of channel establishment was 100%.In the control group,the guidewire slipped out from the percutaneous renal channel when the channel was expanded in 2 patients,and 1 patient lost the channel;the channel loss rate was 3.6%.Conclusion(s):SonixGPS ultrasound navigation system combined with fiber optic ureteroscope to establish percutaneous renal channels in percutaneous nephrolithotomy.This technique has obvious advantages in the intraoperative puncture time,the one-time puncture success rate,the number of percutaneous renal puncture and the decrease of hemoglobin,etc.This technique facilitates accurate puncture of the target calyces and placement of the guidewire in the appropriate position to facilitate the safe establishment of percutaneous renal access.This technique is especially suitable for kidney stone patients with mild hydronephrosis or no hydronephrosis,which improves the safety and success rate of operation.