Endoscopic-guided versus fluoroscopic-guided renal access for percutaneous nephrolithotomy: a comparative analysis

Area of Science:

• Urology
• Endourology
• Nephrolithiasis Management

Background:

• Percutaneous nephrolithotomy (PCNL) is a key procedure for kidney stone removal.
• Optimizing renal access is crucial for PCNL safety and efficacy.
• Fluoroscopic-guided access (FGA) and endoscopic-guided access (EGA) are primary methods for achieving renal access.

Purpose of the Study:

• To compare the intraoperative outcomes of percutaneous renal access using fluoroscopic-guided access (FGA) versus endoscopic-guided access (EGA).
• To evaluate the safety and effectiveness of EGA in PCNL procedures.

Main Methods:

• A retrospective review of 159 patients undergoing PCNL was conducted.
• Patients were categorized by renal access method: FGA or EGA.
• Demographics, operative, and postoperative outcomes were compared using univariate and multivariate analyses.

Main Results:

• Endoscopic-guided access (EGA) resulted in significantly shorter fluoroscopy times (3.2 vs. 16.8 minutes) and fewer accesses needed (1.03 vs. 1.22).
• EGA was associated with a lower rate of procedure termination due to bleeding (0% vs. 8%) and reduced need for secondary stone management procedures (3.2% vs. 12.5%).
• No significant differences were found in hemoglobin change, transfusion rates, operative time, or intraoperative complications between the groups.

Conclusions:

• Endoscopic-guided access (EGA) is a safe and effective alternative for percutaneous renal access in PCNL.
• EGA leads to reduced fluoroscopy exposure, fewer required accesses, and a lower risk of early procedure termination or the need for subsequent interventions.