Renal access by urologist or radiologist during percutaneous nephrolithotomy
Jeffrey J Tomaszewski1, Tara D Ortiz, Bishoy A Gayed
1Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA. tomaszewskijj@upmc.edu
Journal of Endourology
|October 6, 2010
Summary
Urologist access for percutaneous nephrolithotomy (PCNL) is safe and effective, leading to higher stone-free rates compared to interventional radiologist access. Radiologist access for decompression was often inadequate for PCNL.
Area of Science:
- Nephrology
- Urology
- Interventional Radiology
Background:
- Percutaneous nephrolithotomy (PCNL) is a key procedure for kidney stone removal.
- The effectiveness of PCNL depends significantly on successful percutaneous access.
- The roles of urologists and interventional radiologists in obtaining PCNL access are debated.
Purpose of the Study:
- To compare percutaneous access outcomes and complications between urologists and interventional radiologists for PCNL.
- To evaluate the efficacy of access obtained by different specialists in achieving stone-free status.
Main Methods:
- Retrospective review of 233 PCNL cases between 2000-2008.
- Stratification of patients based on access provider: urologists (group 1) vs. interventional radiologists (group 2).
- Comparison of complication rates, stone-free rates, and access difficulty parameters.
Main Results:
- No significant differences in multiple access tracts, stone size, or supracostal tracts between groups.
- Comparable complication rates (14.3% vs. 13.5%) and access difficulty scores.
- Significantly higher stone-free rate in the urology access group (99% vs. 92.1%; P=0.033).
- Radiologist-obtained access was inadequate in 36.8% of cases, requiring additional tract placement.
Conclusions:
- Urologist-obtained access is safe and effective for PCNL.
- Interventional radiologist access for decompression is often insufficient for PCNL.
- Urologist access is associated with improved stone-free rates despite similar stone complexity.
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