***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives : To compare the success and complication rates of sonography-guided supine percutaneous nephrolithotomy ( PCNL ) versus prone st and ard technique ( fluoroscopic guidance ) in a r and omized controlled trial . Subjects and Methods : Between April 2009 and August 2011 , 92 c and i date s for PCNL  were r and omly divided into two groups : 46 B-mode sonography-guided supine PCNL ( group A ) and 46 st and ard fluoroscopic-guided prone PCNL ( group B ) . Demographic , clinical and perioperative patient characteristics were analyzed , and complications and success rates were compared between the two approaches . Results : Preoperative parameters were comparable in the two groups . The primary success rate was 79.0 and 65.2 % in groups A and B , respectively , after one session of PCNL ( p = 0.485 ) . Sonography-guided access failed in 3 cases ( failure rate 6.5 % in group A vs. 0 % in group B ) . Mean hospital stay ( 2.48 days for group A vs. 2.95 days for group B ; p = 0.039 ) and mean nephrostomy tube stay time ( 1.79 days for group A vs. 2.56 days for group B ; p = 0.007 ) were significantly prolonged in the st and ard technique . Postoperative fever was more prevalent in the st and ard PCNL group ( p = 0.024 ) , but no significant difference was observed in other complications between the two groups . Conclusion : In this study , sonography-guided supine PCNL was presented as a safe and effective technique , similar to st and ard PCNL , with comparable success and complication rates . In addition , using this technique eliminates the possible harmful impacts of radiation on the surgical team and decreases postoperative fever BACKGROUND AND PURPOSE Gaining access to the pyelocaliceal system in  percutaneous nephrolithotomy ( PCNL )  is routinely performed using fluoroscopic guidance with the patient in a prone position . We compared ultrasonography-guided access for PCNL with the patient in the flank position with conventional fluoroscopy-guided access . PATIENTS AND METHODS A total of 60 patients were r and omly separated into two 30-patient groups -- namely , ultrasonography-guided access with the patient in the flank position as group 1 , and fluoroscopy-guided access with the patient in the prone position as group 2 . In group 1 , the entire procedure was performed under ultrasonography guidance . RESULTS Successful access was achieved 100 % in both groups . The success rate was 86.7 % in group 1 and 90 % in group 2 ( P = 0.45 ) . The residual stone rate ( stone > or=4 mm ) was 13.3 % in group 1 and 10 % in group 2 . The access duration was 14.5 + /- 2.6 minutes and 9.4 + /- 2.3 minutes in groups 1 and 2 , respectively ( P < 0.05 ) . No significant differences for complications without any adjacent injuries were detected in both groups . Furthermore , the average hospital stay was 2.7 + /- 0.3 and 2.9 + /- 0.3 days accordingly for groups 1 and 2 ( P = 0.89 ) . CONCLUSION Ultrasonography has a high ability to access calculi more easily through the pyelocaliceal system with the patient in the flank position . It is convenient for urologists , and the return to the supine position is possible easily when necessary . Besides , PCNL under ultrasonography guidance and with the patient in the flank position has high success rates and limited complications ; hence , we recommend this technique as an alternative procedure for fluoroscopy-guided PCNL ABSTRACT Introduction and Hypothesis : To compare complications and outcomes of complete  supine percutaneous nephrolithotomy ( csPCNL )  with ultrasound guided and fluoroscopically guided procedure . Material s and Methods : In this r and omized clinical trial study from January 2009 to September 2010 , 26 of 51 patients with renal stones underwent csPCNL with ultrasonographic guidance in all steps of the procedure ( group A ) , and the other 25 patients underwent st and ard fluoroscopically guided csPCNL ( group B ) . All of the patients underwent PCNL  in the complete supine position . Statistical analysis was performed with SPSS16 software . Results :  Mean BMI was 28.14 in group A and 26.31 in group B ( p=0.30 ) . The mean stone burden was 26.48 and 30.44 in groups A and B , respectively ( p=0.20 ) . The stone free rate was 88.5 % in group A and 75.5 % in group B , that was no significant ( p=0.16 ) . Overall 2 patients ( 7.7 % ) in group A and 6 patients ( 24 % ) in group B had complications ( p=0.11 ) . Mean operative time in group A was 88.46 minutes , and in group B it was 79.58 minutes ( p=0.39 ) . Mean hospital stay was 69.70 and 61.79 hours in group A and B , respectively ( p=0.22 ) . There was no visceral injury in groups . Conclusions : This r and omized study showed that totally ultrasonic had the same outcomes of fluoroscopically csPCNL . Ultrasonography can be an alternative rather than fluoroscopy in PCNL . We believe that more r and omized studies are needed to allow endourologists to use sonography rather than fluoroscopy in order to avoid exposition to radiation Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more INTRODUCTION Over the past 20 years , the use of fluoroscopy to guide urologic surgical interventions has been constantly growing . Thus , in their daily practice , urologists and other operating room ( OR ) staff are exposed to X-radiation increasingly frequently . This raises questions as to the risks they encounter and the actions needed to reduce them . OBJECTIVE Evaluate X-ray dose exposure in the members of the surgical team and determine urologist radioprotection knowledge and practice s. MATERIAL S AND METHODS A prospect i ve bicenter study was conducted within AFUF ( French urology resident association ) and in association with The French Nuclear Safety Authority/The Institute for Radiological Protection and Nuclear Safety ( ASN/IRSN ) .  Radiation exposure was measured on 12 operators using  dosimeters  ( seven per operator ) , in staff-occupied locations in the OR using ionization chambers , and on anthropomorphic phantoms . A survey was used to gather information on radiation knowledge and safety practice s of the AFUF members . RESULTS Annual whole-body radiation doses were low ( 0.1 - 0.8 millisieverts [ mSv ] , mostly at around 0.3 mSv ) , and equivalent doses were low for the fingers ( 0.7 - 15 mSv , mostly at around 2.5 mSv ) , and low for the lens of the eye ( 0.3 - 2.3 mSv , mostly at around 0.7 mSv ) . In percutaneous nephrolithotomy , extremity doses were lower when the patient was placed in dorsal decubitus compared with ventral decubitus . Pulsed fluoroscopy reduced radiation dose exposure by a factor of 3 compared with continuous fluoroscopy with no image quality loss . Radiation safety practice s were poor : only 15 % of urologists wore dosimeters and only 5 % had been trained in the h and ling of X-ray generators . CONCLUSION In the present study , radiation exposure for urologists was low , but so was knowledge of radiation safety and optimization practice s. This absence of training for radiation safety and reduction , teamed with novel techniques involving long fluoroscopy-guided interventions , could result in unnecessarily high exposure for patients and OR personnel PURPOSE Achieving access to the pyelocaliceal system in  percutaneous nephrolithotomy ( PCNL ) is routinely performed using fluoroscopic guidance . We compared ultrasonography-guided access for PCNL with conventional fluoroscopy-guided access . PATIENTS AND METHODS In a clinical trial , 100 patients with no abnormality of the upper urinary tract were selected from among c and i date s for PCNL and r and omly assigned to two 50-patient groups : ultrasonography-guided access ( group 1 ) versus fluoroscopy-guided access ( group 2 ) . In group 1 , location of the target calix was identified in the transverse and sagittal planes by real-time ultrasonography when patients were in the prone position . Puncture of the target calix was attempted with a Chiba needle attached to the side of the ultrasound probe . If access to the collecting system was achieved , the site of puncture was controlled using fluoroscopy . In group 2 , access was achieved using fluoroscopy guidance . Tract dilatation and stone extraction were the same in both groups . The mean age of patients was 40.7 + /- 12 years and 41.6 + /- 13.7 years in groups 1 and 2 , respectively ( P = 0.4 ) . The male to female ratio in groups 1 and 2 was 34/16 and 31/19 , respectively ( P = 0.5 ) . RESULTS On average , duration of access was 11 + /- 3.5 minutes and 5.5 + /- 1.7 minutes in groups 1 and 2 , respectively ( P = 0.0001 ) . Duration of radiation exposure , on average , was 0.69 + /- 0.26 minutes and 0.95 + /- 0.44 minutes in groups 1 and 2 , respectively ( P = 0.0001 ) . CONCLUSION Access for PCNL using ultrasonography guidance is an acceptable alternative to fluoroscopy and decreases radiation hazards Abstract Objective : To assess the effectiveness and advantages of ultra-mini-percutaneous nephrolithotomy ( UM-PCNL ) versus st and ard PCNL ( S-PCNL ) , as one of the most important differences between the various PCNL techniques is the size of the renal access , which contributes to the broad spectrum of complications and outcomes . Patients and methods : This clinical r and omised trial was conducted in 2016 . In all , 70 patients with renal or upper ureteric stones of 10–20 mm in diameter , who were c and i date s for PCNL , were divided equally into two groups . Group A , underwent UM-PCNL using a 9.8-F ureteroscope through a 16-F sheath ; and Group B , underwent S-PCNL using a 24-F nephroscope through a 30-F sheath . The stones were fragmented by pneumatic lithotripsy . Any perioperative complications and need for analgesia were recorded , and postoperative pain was assessed in both groups using a visual analogue scale ( VAS ) . Results : There were statistically significant differences in postoperative haemoglobin values , haemoglobin drop , transfusion rate , duration of hospitalisation and postoperative VAS pain score between the groups ( P < 0.05 ) . There were no significant differences in operation time , need for auxiliary procedures or stone-free rate . Conclusion : A minimally invasive UM-PCNL using a 9.8-F ureteroscope can play an important role in the treatment of symptomatic renal and upper ureteric stones of < 20 mm in diameter with lesser blood loss , duration of hospitalisation , need of transfusion , and postoperative pain compared with S-PCNL Background : In this study , we aim ed to explore the effect of ultrasound-guided percutaneous nephrolithotomy ( UGPN ) for the treatment in patients with kidney stones ( KS ) . Methods : We r and omly assigned 86 patients with KS to a UGPN group or a control group , each group comprising 43 patients . Patients from the UGPN group underwent UGPN whereas those from control group underwent fluoroscopic-guided percutaneous nephrolithotomy ( FGPN ) . The primary outcome included the stone-free rate . Secondary outcomes included complication rates , operative time , and length of hospitalization . Results : UGPN did not show better efficacy than the FGPN procedure in decreasing stone-free rate ( UGPN group 79.1 % vs control group 69.8 % , P = .45 ) , operative time  ( UGPN group 108.4 ± 31.7 minute vs control group 113.2 ± 34.5 minute , P = .50 ) , and length of hospitalization  ( UGPN group 2.7 ± 1.3 days vs control group 3.1 ± 1.5 days , P = .19 ) . Additionally , no complications , except fever  ( UGPN group 4.7 % vs control group 9.3 % , P = .41 ) and hemoglobin slightly reduced ( UGPN group 7.0 % vs control group 11.6 % , P = .46 ) were noted in patients from both groups in this study . Conclusions : To summarize , we demonstrated that both UGPN and FGPN techniques showed similar efficacy and complications when used for the management of KS OBJECTIVE To examine the cost factors associated with ultrasound and fluoroscopic guidance for percutaneous nephrolithotomy ( PCNL )  and to determine which method can be performed at a lower cost per case . METHODS A cost comparison study was performed utilizing clinical data 
    Output:
    
Conclusions UG-PCNL is as effective as FG-PCNL and has the advantage of lower complication rates .
In addition , UG-PCNL could be performed with patients in the supine position without compromising its efficacy