الفهرس 
ACKNOWLEDGEMENTOnly 14 pages are availabe for public view
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Abstract
Percutaneous nephrolithotomy (PCNL) for the treatment of renal stones has proved its efficacy. Developments in instrumentation, radiologic imaging, and urologist skill have certainly helped this type of surgery to attain new frontiers in terms of safety and efficacy.
PCNL planning is a crucial step for such complicated stones and complex renal anatomy. preoperative planning should include knowledge of the renal anatomy, pathological features, and therapeutic goal.
The aim of this work is comparison between the outcome of planning using multi-slice CTU and IVU in supine percutaneous nephoolithotomy.
The study conducted on 60 patients with renal stone disease, from March 2011 to october 2012 in urology department, Benha university hospital, and were divided randomly into two groups: group (I), 30 patients, PCNL access will be planned based on IVU and group (II), 30 patients, PCNL access will be planned based on multi-slice CTU
Comparison between both groups had been done as regard to; calyceal puncture, mean time taken to gain percutaneous access, operative time, fluoroscopic time, difficulties in establishing percutaneous access ,stone free rate, intra-operative blood loss, intra & postoperative morbidity and hospital stay.
As regard to calyceal puncture, In group I ,upper calyceal puncture was done in 0 cases, middle calyceal puncture was done in 4 cases, lower calyceal puncture was done in 23 cases and multiple punctures were done in 3 cases. While in group II,upper calyceal puncture was done in 0 cases, middle calyceal puncture was done in 2 cases, lower calyceal puncture was done in 24cases and multiple punctures were done in 4 cases. With no significant statistical differences between both groups.
Mean time taken to gain percutaneous access was longer in group I than in group II, in group I was 22.2 minutes but in group II was 13.1minutes.
Operative time was longer in group (I), (mean ± SD) was 81.9±14.9,(range 65-85 min.),than in group (II) (mean ± SD) was 58.8±7.6,(range 45-65 min), P value < 0.001 with a highly significant statistical differences between the 2 groups.
Fluoroscopic time was longer in group (I) than in group (II),in group (I) was 3.5minutes (range 2-8 min.) but in group (II) was 2.2 (range1-5min.), with a significant statistical differences between the 2 groups.
There were 4 cases (13.3%)in group I had difficulties in establishing percutaneous access,while in group II no case had difficulties. The stone free rate of group (II) is 86.7 % while the stone free rate of group (I) is 83.3% .
The mean hospital stay of group (I) was 3.4 days, while the mean hospital stay of group (II) was 3.1 days with no significant statistical differences between both groups.
In conclusion, multislice CTwith this protocol enables an accurate and confident, reproducible prediction of the site, number, and size of stones in pelvicalyceal anatomy, optimal site(s) for placing the percutaneous track, less operative time, easier access and potential hazards when placing the track,with no significant increase in the patients radiation burden.multislice CT should become the standard imaging method for planning supine PCNL.