Sarcouncil Journal of Medical Sciences

Abstract: Background: Radiologic imaging has transformed minimally invasive urologic procedures, making them more accurate, less invasive, and more beneficial to patients. The purpose of this study is to evaluate the impact of the new radiologic technologies, like intraoperative cone-beam computed tomography (CBCT), fusion imaging, three-dimensional (3D) reconstruction, and contrast-enhanced ultrasound (CEUS), on the procedural results of minimally invasive urological interventions. Procedures performed were percutaneous nephrolithotomy (PCNL, n=38), robot-assisted partial nephrectomy (RAPN, n=29), renal cryoablation (n=22), ureteral stenting with fluoroscopic/CBCT guidance (n=18), and prostate artery embolization (PAE, n=10). Technical success rate, complication rates (Clavien-Dindo classification), radiation dose, operative time, and hospital length of stay were the primary outcomes. Results: with 117 patients collected from Iraq with different hospitals, the overall technical success rate was 95.7% (112/117). The mean operative time was 87.3 ± 34.2 minutes. The overall complication rate was 12.8% (15/117), with 10.3% (12/117) being Clavien-Dindo grade I–II and 2.6% (3/117) grade III. Mean radiation dose was 847.3 ± 412.6 mGy•cm². The average length of hospital stay was 2.8 ± 1.4 days. Fusion imaging also resulted in a significantly shorter fluoroscopy time than conventional guidance (p=0.003). In complex renal procedures, operative time was shorter with 3D reconstruction (p=0.017). Conclusions: High technical success and acceptable complication rates are achieved with the use of advanced radiologic innovations in minimally invasive urological procedures. The advantages of fusion imaging and 3D reconstruction are quantifiable in terms of radiation exposure and operating time, respectively.