Superiority of ultrasound-DSP fusion over CT guidance for percutaneous nephrostomy in complex hydronephrosis: a propensity-matched multicenter cohort study demonstrating enhanced procedural efficiency and secondary ureteroscopy success.

AIM: To compare the procedural efficiency, clinical outcomes, and economic impact of one-stop US-DSP (ultrasound-digital subtraction pyelography) fusion-guided percutaneous nephrostomy (PCN) versus conventional staged CT-guided PCN for complex hydronephrosis.

MATERIALS AND

METHODS

This retrospective, propensity-score matched, multicenter study included consecutive patients with complex hydronephrosis (Society for Fetal Urology grade ≥3 and/or complicated by anatomical/malignant factors) who underwent urgent PCN between 2022 and 2023. Patients were stratified by guidance method (US-DSP fusion vs. CT) and matched 1:1. Primary endpoints were procedural time, number of needle passes, and 2-week secondary ureteroscopy success rate. Secondary outcomes included decompression efficacy, 30-day complications, direct medical costs, and radiation dose.

RESULTS

Sixty matched patient pairs were analyzed. The US-DSP fusion group showed superior performance: 38% shorter median procedural time (22.2 vs. 35.6 min, P<.001), fewer needle passes (1.7 vs. 2.2, P=.005), higher single-pass success rate (65.0% vs. 38.3%, P=.003), and higher secondary ureteroscopy success rate (93.3% vs. 75.0%, P=.002). It also reduced median radiation dose by 58% (9.2 vs. 22.0 mSv, P<.001) and direct costs by 19.3% (¥5,862 vs. ¥7,266, P<.001), without increasing complications (5.0% vs. 10.0%, P=.310).

CONCLUSION

US-DSP fusion-guided one-stop PCN outperforms CT-guided staged PCN for complex hydronephrosis, enhancing efficiency, facilitating downstream treatment, and reducing radiation exposure and costs, supporting its adoption as the preferred approach.