Background: Percutaneous nephrolithotomy (PCNL) has become the gold-standard treatment for the management of large renal stones (>2 cm) and complex calculi, including staghorn stones, due to its high efficacy and minimally invasive nature. The standard approach to accessing the pelvicalyceal system begins with the placement of a ureteral catheter, followed by the administration of contrast media, air, or carbon dioxide (CO?) to opacify the collecting system.
Materials and Methods: A prospective study was conducted from 1st August 2023 to 28th February 2025, after taking approval from the Institutional Research and Ethics committee, Sri Guru Ram Das University of Health Sciences, Vallah, Amritsar. Patients were randomly divided into 2 groups, one group including 30 patients who underwent Carbon dioxide with contrast (diatrizoate meglumine 76%) pyelogram during surgery and the other group including 30 patients who underwent contrast (diatrizoate meglumine 76%) pyelogram during surgery for pelvicalyceal system identification.
Result: The analysis of 60 cases demonstrated that Carbon dioxide pyelogram along with contrast pyelogram is better in comparison to using only contrast pyelogram in terms of better calyceal puncture, reduced radiation exposure time, accuracy of procedure, reduced number of post-operative complications.
Conclusion: Taking advantage of both carbon dioxide and contrast media in retrograde pyelography, we have merged them both for better calyceal puncture, reduced time needed for puncture, reduced radiation exposure and less exposure to contrast media (due to reduced amount).
Keywords: Carbon dioxide pyelogram, Contrast pyelogram, Renal calculi, Percutaneous nephrolithotomy, Pelvicalyceal system
