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Objective <p>To prospectively evaluate the technical success rate, safety profile, and clinical outcomes of using air pyelogram to guide percutaneous access in percutaneous nephrolithotomy (PCNL).</p> Materials and methods <p>This prospective observational study included 350 consecutive patients undergoing PCNL between July 2025 and December 2025. A standardized air pyelogram protocol was followed with a maximum of 10 mL room air instilled retrogradely. Primary outcomes were technical success of calyceal visualization and incidence of complications, particularly venous air embolism (VAE). Secondary outcomes included stone-free rate (SFR), fluoroscopy time, and comparison between air-only and air-contrast groups in which air pyelogram failed and contrast was needed.</p> Results <p>Air alone provided adequate visualization in 318 patients (90.9%), with only 32 (9.1%) requiring conversion to contrast. Upper calyx visualization was achieved in 98.6% of cases. Overall SFR at 4 weeks was 91.7%. Major complications (Clavien-Dindo ≥ 2) occurred in 6% of patients, with no clinical evidence of venous air embolism. The air-only group demonstrated significantly superior outcomes compared to the air-contrast group: higher SFR (92.8% vs. 81.3%, <i>p</i> = 0.024), fewer access attempts (1.15 ± 0.42 vs. 2.19 ± 1.2, <i>p</i> &lt; 0.001), shorter fluoroscopy time (308.1 ± 105.1 vs. 481.5 ± 157.4&#xa0;s, <i>p</i> &lt; 0.001), and shorter operative time (35.8 ± 17.5 vs. 45.9 ± 21.6&#xa0;min, <i>p</i> = 0.014).</p> Conclusion <p>Air pyelogram with a standardized low-volume protocol is a safe, effective, and radiation-sparing technique for guiding percutaneous access in PCNL. It provides excellent visualization of posterior calyces with no demonstrable risk of venous air embolism when strict volume limits are observed.</p>

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Clinical outcomes and safety profile of air pyelogram to guide percutaneous access in percutaneous nephrolithotomy – a prospective study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月22日

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  • Kartikesh Mishra,
  • Ram Sagar Shah,
  • Abhisek Paudel

摘要

Objective

To prospectively evaluate the technical success rate, safety profile, and clinical outcomes of using air pyelogram to guide percutaneous access in percutaneous nephrolithotomy (PCNL).

Materials and methods

This prospective observational study included 350 consecutive patients undergoing PCNL between July 2025 and December 2025. A standardized air pyelogram protocol was followed with a maximum of 10 mL room air instilled retrogradely. Primary outcomes were technical success of calyceal visualization and incidence of complications, particularly venous air embolism (VAE). Secondary outcomes included stone-free rate (SFR), fluoroscopy time, and comparison between air-only and air-contrast groups in which air pyelogram failed and contrast was needed.

Results

Air alone provided adequate visualization in 318 patients (90.9%), with only 32 (9.1%) requiring conversion to contrast. Upper calyx visualization was achieved in 98.6% of cases. Overall SFR at 4 weeks was 91.7%. Major complications (Clavien-Dindo ≥ 2) occurred in 6% of patients, with no clinical evidence of venous air embolism. The air-only group demonstrated significantly superior outcomes compared to the air-contrast group: higher SFR (92.8% vs. 81.3%, p = 0.024), fewer access attempts (1.15 ± 0.42 vs. 2.19 ± 1.2, p < 0.001), shorter fluoroscopy time (308.1 ± 105.1 vs. 481.5 ± 157.4 s, p < 0.001), and shorter operative time (35.8 ± 17.5 vs. 45.9 ± 21.6 min, p = 0.014).

Conclusion

Air pyelogram with a standardized low-volume protocol is a safe, effective, and radiation-sparing technique for guiding percutaneous access in PCNL. It provides excellent visualization of posterior calyces with no demonstrable risk of venous air embolism when strict volume limits are observed.