# Impact of fluoroscopy technique on radiation time and surgical outcomes in supine percutaneous nephrolithotomy: a propensity score-matched analysis of intermittent versus live fluoroscopy

## TL;DR

This study compares intermittent and live fluoroscopy during kidney stone surgery, finding that intermittent use reduces radiation exposure without affecting surgical outcomes.

## Contribution

The novel contribution is demonstrating that intermittent fluoroscopy significantly reduces fluoroscopy time without compromising clinical outcomes in supine PCNL.

## Key findings

- Intermittent fluoroscopy reduced median fluoroscopy time from 267 seconds to 25.5 seconds.
- Stone-free rates and complication rates were similar between intermittent and live fluoroscopy groups.
- Operative time and hospital stay were not significantly different between the two groups.

## Abstract

Fluoroscopy is commonly used during Percutaneous Nephrolithotomy (PCNL) for renal access and tract dilatation; however, it is associated with radiation exposure for both patients and surgical staff. Strategies to minimize exposure include reducing fluoroscopy time, which serves as a surrogate marker of radiation dose. This study aims to examine the effect of reducing fluoroscopy time using intermittent fluoroscopy on treatment and perioperative outcomes in supine PCNL.

We retrospectively analyzed data from 446 patients who underwent supine PCNL between April 2021 and August 2025. After applying exclusion criteria, 392 patients were included. Two experienced surgeons performed or supervised the procedures, one utilizing intermittent fluoroscopy and the other live fluoroscopy. Baseline demographics, stone characteristics, operative variables, fluoroscopy time, stone-free rates (SFR), complications, and hospital stay were compared. Propensity score matching (PSM) was conducted to minimize group baseline differences.

Before matching, 310 patients underwent intermittent fluoroscopy, and 82 underwent live fluoroscopy. After PSM, 82 patients remained in each group with comparable demographics and stone characteristics. Median fluoroscopy time was significantly lower in the intermittent group (25.5 s [IQR: 18–35.25]) compared with the live group (267 s [IQR: 182.5–314]; p < 0.001). Stone-free rates were similar (79.3% vs. 81.7%; p = 0.694), as were operative time, hospital stay, and complication rates(all p > 0.05).

Intermittent fluoroscopy during supine PCNL substantially reduces fluoroscopy time without compromising stone-free rates, operative outcomes, or complication rates. This approach may be considered a safer alternative for minimizing radiation exposure to patients and healthcare providers.