Upper pole urologist-obtained percutaneous renal access for PCNL is safe and efficacious

Interventional radiologist may be hesitant to obtain upper pole access for percutaneous nephrolithotomy (PCNL) due to a higher complication rate. Renal access gained by urologists may achieve higher stone-free rates with similar complication rates. We evaluate our institution's contemporary results of percutaneous renal access in the upper pole for nephrolithotomy by urologists, which we believe both safe and efficacious.

This retrospective chart review included all PCNL's performed by fellowship-trained endourologists from 2003 to 2014 at a single institution. Inclusion criteria included patients in which renal access was obtained by the urologist via the upper pole for PCNL. Stone-free status was determined by either KUB or CT scan on POD #1. Patients without stones visible on KUB or less than 4 mm on CT were considered stone-free.

A total of 144 patients obtained upper pole access for PCNL. There were a total of 53 (37%%) staghorn calculi, of which 35 (66%) were partial staghorn stones. Renal access was obtained above 11th rib in 12.5% (n = 18), between the 11th and 12th rib in 57.6% (n = 83), subcostal in 14.6% (n = 21) and undetermined in the rest. Complications were seen in 18 (12.5%) of patients. Hydropneumothorax requiring chest tube was seen in 8 (5.6%) patients. Postoperative imaging confirmed 93 (64.5%) patients stone-free, and 35 (24.3%) required a second look PCNL.

Our experience with upper pole percutaneous renal access for nephrolithotomy has shown that it has an acceptable complication risk. It should be a part of an endourologist's armamentarium that operate on large burden, complex stones or ureteral pathology.