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Impact of Implementing Contrast-Enhanced Ultrasound for Antegrade Nephrostogram After Percutaneous Nephrolithotomy.

Publication ,  Journal Article
Fetzer, DT; Flanagan, J; Nabhan, A; Pongsatianwong, K; Antonelli, J; Pearle, M; Vijay, K; Watumull, L
Published in: J Ultrasound Med
January 2021

OBJECTIVES: To report results from a quality improvement (QI) project evaluating diagnostic performance, hospital resource use, and patient response data for postoperative contrast-enhanced ultrasound (CEUS) antegrade nephrostogram after percutaneous nephrolithotomy. METHODS: For this Health Insurance Portability and Accountability Act-compliant, Institutional Review Board-approved study, QI data were deidentified and analyzed. On the first postoperative day after percutaneous nephrolithotomy, patients underwent both CEUS and fluoroscopic antegrade nephrostogram. For CEUS, 1.0 mL of Lumason (sulfur hexafluoride lipid type A microspheres; Bracco Diagnostics, Inc, Monroe Township, NJ) was injected via an indwelling nephrostomy tube, with ureteral patency confirmed by identifying intravesical ultrasound (US) contrast. Diagnostic performance for ureteral patency and contrast extravasation was calculated (with fluoroscopy as the reference standard). The examination time, room time, physician time, hospital costs, and patient response data were compared. The mean, standard deviation, 95% confidence interval, differences in mean, and 95% confidence interval of differences were calculated. RESULTS: Eighty-one examinations were performed in 73 patients during the QI period. The sensitivity and specificity of CEUS for ureteral patency were 96% and 57%, respectively. There was no significant difference in time metrics between modalities, and the cost analysis showed lower direct and indirect costs for CEUS. Patient responses revealed lower levels of comfort for CEUS relative to fluoroscopy, without significant differences in reported pain or effort levels. CONCLUSIONS: Contrast-enhanced US showed very high sensitivity for ureteral patency; the relatively low specificity may have resulted from false-negative results in fluoroscopy. The hospital costs and resource use of CEUS compared favorably to fluoroscopy. Contrast-enhanced US also offers inherent advantages, including portability and lack of ionizing radiation.

Duke Scholars

Published In

J Ultrasound Med

DOI

EISSN

1550-9613

Publication Date

January 2021

Volume

40

Issue

1

Start / End Page

101 / 111

Location

England

Related Subject Headings

  • Ultrasonography
  • Sulfur Hexafluoride
  • Phospholipids
  • Nuclear Medicine & Medical Imaging
  • Nephrolithotomy, Percutaneous
  • Humans
  • Fluoroscopy
  • Contrast Media
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Fetzer, D. T., Flanagan, J., Nabhan, A., Pongsatianwong, K., Antonelli, J., Pearle, M., … Watumull, L. (2021). Impact of Implementing Contrast-Enhanced Ultrasound for Antegrade Nephrostogram After Percutaneous Nephrolithotomy. J Ultrasound Med, 40(1), 101–111. https://doi.org/10.1002/jum.15380
Fetzer, David T., Jennifer Flanagan, Ali Nabhan, Kim Pongsatianwong, Jodi Antonelli, Margaret Pearle, Kanupriya Vijay, and Lori Watumull. “Impact of Implementing Contrast-Enhanced Ultrasound for Antegrade Nephrostogram After Percutaneous Nephrolithotomy.J Ultrasound Med 40, no. 1 (January 2021): 101–11. https://doi.org/10.1002/jum.15380.
Fetzer DT, Flanagan J, Nabhan A, Pongsatianwong K, Antonelli J, Pearle M, et al. Impact of Implementing Contrast-Enhanced Ultrasound for Antegrade Nephrostogram After Percutaneous Nephrolithotomy. J Ultrasound Med. 2021 Jan;40(1):101–11.
Fetzer, David T., et al. “Impact of Implementing Contrast-Enhanced Ultrasound for Antegrade Nephrostogram After Percutaneous Nephrolithotomy.J Ultrasound Med, vol. 40, no. 1, Jan. 2021, pp. 101–11. Pubmed, doi:10.1002/jum.15380.
Fetzer DT, Flanagan J, Nabhan A, Pongsatianwong K, Antonelli J, Pearle M, Vijay K, Watumull L. Impact of Implementing Contrast-Enhanced Ultrasound for Antegrade Nephrostogram After Percutaneous Nephrolithotomy. J Ultrasound Med. 2021 Jan;40(1):101–111.

Published In

J Ultrasound Med

DOI

EISSN

1550-9613

Publication Date

January 2021

Volume

40

Issue

1

Start / End Page

101 / 111

Location

England

Related Subject Headings

  • Ultrasonography
  • Sulfur Hexafluoride
  • Phospholipids
  • Nuclear Medicine & Medical Imaging
  • Nephrolithotomy, Percutaneous
  • Humans
  • Fluoroscopy
  • Contrast Media
  • 3202 Clinical sciences
  • 1103 Clinical Sciences