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Improved communication between urology and interventional radiology (IR) for percutaneous nephrolithotomy (PCNL) access planning significantly reduced the need for additional surgical access. This collaboration enhances PCNL success rates for complex kidney stones.

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Area of Science:

  • Urology
  • Interventional Radiology
  • Nephrolithotomy

Background:

  • Percutaneous nephrolithotomy (PCNL) success relies on proper antegrade access, which can be challenging.
  • Prior studies in emergent settings showed high rates of repeat access during PCNL when using interventional radiology (IR) obtained access.

Purpose of the Study:

  • To evaluate if improved pre-procedural communication between urology and IR impacts the utility of IR-obtained antegrade access for subsequent PCNL.
  • To assess the rate of additional access required during PCNL following IR-established preoperative access, with a focus on planned versus unplanned access.

Main Methods:

  • Retrospective review of 141 adult patients undergoing PCNL with preoperative antegrade access from January 2011 to December 2022.
  • Analysis of cases with planned IR access versus unplanned access, considering patient factors like anatomic abnormality, staghorn calculus, and BMI.

Main Results:

  • 111 of 141 patients had planned IR access. Patients with planned access had higher BMI, anatomic abnormalities (50%), and staghorn calculus (53%).
  • While 97% of cases initially utilized preoperative access, only 6% required additional intraoperative access.
  • Planned access significantly reduced the rate of new access compared to unplanned access (4% vs. 17%, p=0.02). Stone-free rates, secondary procedures, and complication rates were similar between groups.

Conclusions:

  • Preoperative antegrade access planned with urologist involvement resulted in a lower rate of new access compared to previous reports.
  • Collaboration between urology and IR in planning access is crucial for optimizing PCNL outcomes, especially in complex cases with large stone burdens.