Contrast-enhanced ultrasound (CEUS) guided percutaneous nephrolithotomy (PCNL) facilitates detection of the renal calyx fornix, and benefits more accurate renal puncture and less hemoglobin loss. Findings demonstrate feasibility of CEUS-guided PCNL in flank position for treating kidney stone patients with no apparent hydronephrosis.

• In this study, 72 kidney stone patients with no or mild hydronephrosis who were randomly assigned into two groups: a CEUS-guided PCNL group and a conventional ultrasound (US)-guided group, were analyzed.

• Significantly higher success rate of puncture via calyceal fornix was achieved in the CEUS-guided group vs conventional US-guided group (86.1 vs. 47.2%).

• Shorter renal puncture time was reported for CEUS-guided PCNL than conventional US-guided group (36.5 s vs. 61.0 s).

• In the CEUS-guided group, significantly lower median postoperative hemoglobin loss was noted compared with that in the conventional US-guided group (2.5 vs 14.5 g/L).

• With regard to success rate of a single-needle puncture, operative time, stone-free rate, incidence of complications and postoperative stay, there were no statistically significant differences between the two groups.