Trial reportBJU international2026
Computed tomography-ultrasonography (US) fusion for percutaneous nephrolithotomy access versus conventional US: A multicentre randomised trial.
Trial report in BJU international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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11 authors.
Funding
Abstract
objectiveTo assess whether computed tomography-ultrasonography (CT-US) fusion navigation, compared with conventional US guidance, improves first-pass success and related access outcomes in a multicentre randomised trial, as accurate renal access is critical in percutaneous nephrolithotomy (PCNL). PATIENTS AND
methodsBetween March and December 2024, 180 adults with renal stones >2 cm scheduled for PCNL at five centres in China were randomised (1:1, stratified by centre) to CT-US fusion or conventional US guidance. The primary outcome was first-pass success (guidewire in pre-specified target calyx with single capsular traversal). Secondary outcomes included puncture attempts, 24-h haemoglobin drop, major bleeding complications (per-patient composite of transfusion or angiographic embolisation), 30-day stone-free rate (no fragments ≥4 mm on non-contrast CT), overall complications, hospital stay, and surgeon procedural comfort. Analyses were intention-to-treat.
resultsFirst-pass success was higher with CT-US fusion (93.3% vs 78.9%; risk ratio 1.18, 95% confidence interval [CI] 1.05-1.33; risk difference [RD] 14.4%, 95% CI 4.3-24.6%; P = 0.009). Haemoglobin drop was smaller (mean difference -3.45 g/L, 95% CI -6.53 to -0.37 g/L; P = 0.028). Major bleeding complications occurred only in the conventional US group (0% vs 6.7%; RD -6.7%, 95% CI -13.8% to -1.2%; P = 0.029; exploratory). Stone-free rates, overall complications, and hospital stay were similar. Procedural comfort was rated higher with CT-US fusion on the 5-point Likert scale (median score 5 vs 3; P < 0.001).
conclusionsCompared with conventional US guidance, CT-US fusion improved first-pass success during PCNL and was associated with a smaller 24-h haemoglobin drop without compromising efficacy. Further studies are needed to evaluate rare major bleeding events.
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