Color Doppler ultrasound-guided tract creation reduces bleeding in percutaneous nephrolithotomy: an overlap-weighted cohort study
- 1¹Department of Urology, Hechi Hospital, The First Affiliated Hospital of Guangxi Medical University
Abstract
To compare the effects of Color Doppler flow imaging (CDFI) versus conventional two-dimensional ultrasound (2D-US) on bleeding control and surgical outcomes during percutaneous nephrolithotomy (PCNL). Between January 2023 and December 2024, 268 consecutive patients were enrolled in this retrospective-prospective hybrid cohort study. 134 patients received conventional two-dimensional ultrasound-guided puncture (2023 historical control cohort), and another 134 patients received CDFI-guided puncture that avoided renal vessels ≥ 2 mm (2024 observational cohort). This trial was retrospectively registered in ChiCTR (ChiCTR2500114024) on December 5, 2025. The primary endpoint was intraoperative estimated blood loss; postoperative hemoglobin decline was set as a supporting collinear derived measure. Secondary endpoints included transfusion, interventional embolization, stone-free rate, and perirenal hematoma. Overlap-weighting was used to balance baseline stone burden, and Benjamini-Hochberg FDR correction was applied for multiple secondary comparisons. After weighting, CDFI-guided PCNL significantly reduced the primary endpoint of intraoperative blood loss (304.8 ± 17.3 mL vs. 373.3 ± 23.8 mL; effect − 68.6 mL; 95% CI − 126.1, − 11.0; P = 0.020). The collinear supporting measure of postoperative hemoglobin decline showed a consistent reduction (9.51 ± 0.53 g L⁻¹ vs. 11.73 ± 0.75 g L⁻¹; effect − 2.22 g L⁻¹; 95% CI − 4.02, − 0.42; P = 0.016), but was not treated as an independent confirmatory outcome. Stone-free rates, transfusion, embolization, and hematoma rates were comparable after FDR correction (all P > 0.05). CDFI guidance during 18-Fr single-tract PCNL is associated with a statistically significant reduction in intraoperative estimated blood loss, with a consistent supporting trend in hemoglobin decline, without compromising stone clearance efficacy. These findings support CDFI as a useful adjunctive optimization tool for renal access, but confirmatory multicenter randomized trials are still required.
Related
- Clinical curative effect of B-ultrasound-guided minimally invasive percutaneous nephrolithotomy and its influences on stone clearance rate in patients with complex kidney stones.
- Lung ultrasound-guided protocolized fluid management versus conventional central venous pressure-based management in monitoring extravascular lung water during the perioperative period of percutaneous nephrolithotomy: a randomized controlled trial.
- Editorial comment: Craniocaudal bull's eye technique for superior calyceal access during percutaneous nephrolithotomy: Determination of angle, efficacy, and outcomes.
- Miniaturized Versus Standard-Tract Percutaneous Nephrolithotomy for Renal Calculi Larger Than 2 cm: Tract Caliber Determines Hemorrhagic Morbidity Without Compromising Stone Clearance
- Ultrasonic-With-Ballistic Versus Pneumatic Lithotripsy in Percutaneous Nephrolithotomy for 2-4 cm Renal Calculi: A Prospective Quasi-experimental Comparative Study in a Bangladeshi Tertiary-Care Hospital
BibTeX
@article{yan2026color,
title = {{Color Doppler ultrasound-guided tract creation reduces bleeding in percutaneous nephrolithotomy: an overlap-weighted cohort study}},
author = {Xian-Yong Yan and Jing-Zhi Huang and Qing-Fan Wei and Rong-Yuan Wei and Jiang Qin and Hai Lu},
journal = {Scientific Reports},
year = {2026},
month = aug,
doi = {10.1038/s41598-026-67426-9},
url = {https://doi.org/10.1038/s41598-026-67426-9},
note = {CC BY},
}
RIS
TY - JOUR
TI - Color Doppler ultrasound-guided tract creation reduces bleeding in percutaneous nephrolithotomy: an overlap-weighted cohort study
AU - Xian-Yong Yan
AU - Jing-Zhi Huang
AU - Qing-Fan Wei
AU - Rong-Yuan Wei
AU - Jiang Qin
AU - Hai Lu
PY - 2026
DA - 2026/08/01
JO - Scientific Reports
DO - 10.1038/s41598-026-67426-9
UR - https://doi.org/10.1038/s41598-026-67426-9
AB - To compare the effects of Color Doppler flow imaging (CDFI) versus conventional two-dimensional ultrasound (2D-US) on bleeding control and surgical outcomes during percutaneous nephrolithotomy (PCNL). Between January 2023 and December 2024, 268 consecutive patients were enrolled in this retrospective-prospective hybrid cohort study. 134 patients received conventional two-dimensional ultrasound-guided puncture (2023 historical control cohort), and another 134 patients received CDFI-guided puncture that avoided renal vessels ≥ 2 mm (2024 observational cohort). This trial was retrospectively registered in ChiCTR (ChiCTR2500114024) on December 5, 2025. The primary endpoint was intraoperative estimated blood loss; postoperative hemoglobin decline was set as a supporting collinear derived measure. Secondary endpoints included transfusion, interventional embolization, stone-free rate, and perirenal hematoma. Overlap-weighting was used to balance baseline stone burden, and Benjamini-Hochberg FDR correction was applied for multiple secondary comparisons. After weighting, CDFI-guided PCNL significantly reduced the primary endpoint of intraoperative blood loss (304.8 ± 17.3 mL vs. 373.3 ± 23.8 mL; effect − 68.6 mL; 95% CI − 126.1, − 11.0; P = 0.020). The collinear supporting measure of postoperative hemoglobin decline showed a consistent reduction (9.51 ± 0.53 g L⁻¹ vs. 11.73 ± 0.75 g L⁻¹; effect − 2.22 g L⁻¹; 95% CI − 4.02, − 0.42; P = 0.016), but was not treated as an independent confirmatory outcome. Stone-free rates, transfusion, embolization, and hematoma rates were comparable after FDR correction (all P > 0.05). CDFI guidance during 18-Fr single-tract PCNL is associated with a statistically significant reduction in intraoperative estimated blood loss, with a consistent supporting trend in hemoglobin decline, without compromising stone clearance efficacy. These findings support CDFI as a useful adjunctive optimization tool for renal access, but confirmatory multicenter randomized trials are still required.
SN - 2045-2322
ER -