First-in-clinical Evaluation of Dual Contrast-enhanced Ultrasound-guided PCNL: A Multicenter Randomized Trial Versus Fluoroscopy
In brief
Contrast-enhanced ultrasound raises first-pass kidney access to 92%, versus 80% with X-rays
In a two-center randomized trial of 150 patients undergoing kidney stone surgery, contrast-enhanced ultrasound guidance increased first-attempt access success from 80% to 92% and shortened puncture time, tract creation and hospital stay. Complication rates did not differ significantly; the open-label trial supports further evaluation of this radiation-free approach, not yet a definitive change in practice.
- Journal
- European urology focus (Q1)
- Published
- 1 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Donglai Shen, Shoupeng Li, Zhi Li, Haomin Liang, Wei Zhu, Hairui Chen, et al.
- PMID
- 42823258
- DOI
- 10.1016/j.euf.2026.09.003
Why clinicians should know about it
- Picked for Urology (top studies of the week, 4 October 2026): Dual contrast‑enhanced US improves PCNL access
Abstract
BACKGROUND AND OBJECTIVE: Puncture is critical in percutaneous nephrolithotomy (PCNL), influencing access failure and vascular or adjacent organ injury. This study aimed to compare the clinical efficacy and safety of dual contrast-enhanced ultrasound (D-CEUS) with fluoroscopic guidance for renal access during PCNL. METHODS: This two-center prospective trial was conducted between January 2024 and November 2024. A total of 150 patients were randomized to the D-CEUS group (n = 75) or the fluoroscopy group (n = 75). Outcomes included first-attempt puncture success rate, puncture and tract establishment time, stone-free rate, hospital stay, hemoglobin changes, and complications. KEY FINDINGS AND LIMITATIONS: In the intention-to-treat analysis, the first-attempt puncture success rate was higher with D-CEUS than with fluoroscopy (92% vs 80%; difference 12%, 95% confidence interval [CI] = 0.77-23%; Mantel-Haenszel odds ratio [OR] 2.87, 95% CI = 1.04-7.87; p = 0.040). The per-protocol analysis showed consistent results (95% vs 83%; difference 11%, 95% CI = 0.81-22%; Mantel-Haenszel OR 3.45, 95% CI = 1.06-11.24; p = 0.040). Median puncture time (56 vs 120 s; p < 0.001) and tract establishment time (236 vs 480 s; p < 0.001) were shorter with D-CEUS. Median hospital stay was shorter (2 vs 5 d; p < 0.001), with lower hemoglobin loss (median 7.0 vs 11.5 g/l; p = 0.023). There was no significant difference in the complication rate (8.2% vs 15%; p = 0.19). A limitation is that the open-label design may compromise the robustness of the findings. CONCLUSIONS AND CLINICAL IMPLICATIONS: D-CEUS facilitates accurate and safe puncture, efficient tract establishment, and real-time confirmation of calyceal access while avoiding radiation exposure. These findings support further evaluation of D-CEUS as a radiation-free alternative to fluoroscopy for renal access during PCNL.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.