To assess how much can fluoroscopy assisted ultrasound guided puncture reduce radiation exposure in percutaneous nephrolithotomy (PCNL), and can it achieve equivalent results compared to the traditinoal fluorosocpy technique in PCNL.

From July 2022 to August 2023, 50 patients receiving mini-PCNL were included in a prospective randomized study. Two groups of 25 patients each were formed. Those in group A received fluoroscopy-only guided puncture, whereas those in group B received fluoroscopy assisted ultrasound guided puncture. Analysis was done on the following variables: stone-free rate, complication rate, fluoroscopy time, and demographic data.

Mean age in group A compared to group B was 7.24±3.72 vs 8.0±3.77years, respectively. The addition of ultrasonic guiding resulted in a considerable reduction in fluoroscopy duration, from 157.9±68.54 seconds in group A to 29.44±17.01 seconds in group B (P<.05). The radiation dosage was significantly lower in group B (6.07±3.57) mGy compared to group A (32.35±13.79) mGy (P<.05). In group A, the time to puncture was 136.6±50.78 (second), but in group B, it was 52.20±33.20 (second) (P<.05). The universal stone-free rate was 95.3%, with no discernible statistical trend. Group A's complications rate was 16%, while group B reported complication rate of 12%, with no statistically significant difference (P .653).

Fluoroscopy-assisted ultrasound guidance in mini-PCNL is a safer and more effective approach than fluoroscopy alone in our experience.