Renal access by urologist or radiologist during percutaneous nephrolithotomy.

PURPOSE

We evaluated percutaneous access for percutaneous nephrolithotomy (PCNL) that was obtained by interventional radiologists or urologists at a single academic institution and compared access outcomes and complications.

PATIENTS AND METHODS

The records of 233 patients who underwent PCNL at the University of Pittsburgh Medical Center between 2000 and 2008 were retrospectively reviewed. Patients were stratified according to percutaneous access by urologists (group 1) or a group of interventional radiologists (group 2) in 195 and 38 patients, respectively. Radiologist-acquired access was performed for collecting system decompression in 33.3% of patients in group 2. A predicted access difficulty score was calculated using demographic, stone, and operative variables. Percutaneous access complications and stone-free rates were compared between groups.

RESULTS

Mean patient age was 53 ± 16 years (51% male, range 19-90 y) and 58 ± 17 years (62% male, range 25-95 y) in groups 1 and 2, respectively. Use of multiple access tracts (4.3% vs 5.4%; P = 0.54), mean stone diameter (3.5 ± 1.8 cm vs 3.6 ± 1.9 cm; P = 0.97), and percentage of supracostal tracts (36% vs 35%; P = 0.63) were comparable between groups. Mean access difficulty parameters were comparable between groups. The percentage of staghorn calculi (39% vs 30%; P = 0.28) and number of obese (body mass index > 30) patients (30% vs 38%; P = 0.34) were also comparable between groups 1 and 2. The complication rate was the same in the two groups (14.3% vs 13.5%; P = 0.52). The overall stone-free rate was significantly greater in the urology access group (99% vs 92.1%; P = 0.033) on univariate analysis. Radiologist-obtained access could not be used in 36.8% of patients, necessitating additional access tract placement at the time of surgery.

CONCLUSIONS

Urologist-obtained access is safe and effective for PCNL. Access obtained by radiologists for decompression of infected or obstructed systems often is not adequate for PCNL. Despite similar stone complexity and access difficulty, urologist-obtained access was associated with a statistically significant improvement in overall stone-free rate.