Renal access by sonographer versus urologist during percutaneous nephrolithotomy

Area of Science:

• Urology
• Nephrolithotomy
• Medical Imaging

Background:

• Percutaneous nephrolithotomy (PCNL) is a key procedure for kidney stone removal.
• The method of obtaining percutaneous access can influence procedure outcomes.
• Evaluating access by sonographer versus urologist is crucial for optimizing PCNL.

Purpose of the Study:

• To compare percutaneous access outcomes and complications in PCNL.
• To assess the impact of access provider (sonographer vs. urologist) on stone-free rates and complications.
• To guide best practices for renal access during PCNL.

Main Methods:

• Retrospective review of 259 PCNL cases.
• Patients grouped by percutaneous access provider: sonographer (174) vs. urologist (85).
• Comparison of demographic, stone, operative variables, complications, and stone-free rates.

Main Results:

• Complication rates, blood loss, and transfusion rates were similar between groups.
• Sonographers favored subcostal and lower calyx access more frequently than urologists.
• Urologist access group showed significantly higher stone-free rates (90.6% vs. 79.9%) and lower need for post-op SWL (4.7% vs. 13.2%).

Conclusions:

• Both sonographers and urologists can achieve safe renal access for PCNL.
• Infracostal and lower calyx access, preferred by sonographers, correlated with poorer stone-free rates.
• Urologists performing their own renal access during PCNL is recommended for improved stone clearance.