[36] Dynamic contrast-enhanced ultrasonography for better percutaneous nephrolithotomy puncture

Objective: To assess the efficiency of dynamic contrast-enhanced ultrasonography (DCE-US) for percutaneous nephrolithotomy (PCNL) puncture, as in recent years US contrast agents (microbubbles) have been used safely for cardiovascular and liver diseases diagnosis, and also to identify complex renal cysts, thus could be used to better delineate the pyelocalyceal system during PCNL puncture and reduce the radiation exposure for medical staff and patients. Methods: A 40-year-old man with a history of thalassaemia trait, renal cysts, and bilateral renal staghorn stones was scheduled for right PCNL. A 6-F ureteric catheter was placed at the beginning of the procedure. Using a curvilinear US probe (frequency 4 Hz, mechanical index 0.4) and 18-G EchoTip® needle, renal access was established for the patient in prone position under general anaesthesia whilst slowly injecting three doses of 1.5 mL US contrast agent (Sonovue; prepared by mixing 5 mL sodium chloride 0.9% with 25 mg lyophilised powder) each followed by 5 mL physiological saline flush through the ureteric catheter to delineate the collecting system. Afterwards, pneumatic and ultrasonic lithotripsies were used. Results: The PCNL procedure was successful. The collecting system was successfully accessed through a lower calyx puncture. No blood transfusion was needed during or after the procedure (haemoglobin op