Percutaneous nephrolithotomy access by urologist or interventional radiologist: practice and outcomes in the UK.

Publisher: Blackwell Science Country of Publication: England NLM ID: 100886721 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1464-410X (Electronic) Linking ISSN: 14644096 NLM ISO Abbreviation: BJU Int Subsets: MEDLINE

Original Publication: Oxford, UK : Blackwell Science, c1999-

Nephrostomy, Percutaneous*/methods ; Radiology, Interventional* ; Urology*; Kidney Calculi/*surgery; Humans ; Length of Stay ; Practice Patterns, Physicians' ; Treatment Outcome ; United Kingdom

Objective: To compare outcomes of urologist vs interventional radiologist (IR) access during percutaneous nephrolithotomy (PCNL) in the contemporary UK setting.
Patients and Methods: Data submitted to the British Association of Urological Surgeons PCNL data registry between 2009 and 2015 were analysed according to whether access was obtained by a urologist or an IR. We compared access success, number and type of tracts, and perceived and actual difficulty of access. Postoperative outcomes, including stone-free rates, lengths of hospital stay and complications, including transfusion rates, were also compared.
Results: Overall, percutaneous renal access was undertaken by an IR in 3453 of 5211 procedures (66.3%); this rate appeared stable over the entire study period for all categories of stone complexity and in cases where there was predicted or actual difficulty with access. Only 1% of procedures were abandoned because of failed access and this rate was identical in each group. IRs performed more multiple tract access procedures than urologists (6.8 vs 5.1%; P = 0.02), but had similar rates of supracostal punctures (8.2 vs 9.2%; P = 0.23). IRs used ultrasonograhpy more commonly than urologists to guide access (56.6% vs 21.7%, P < 0.001). There were no significant differences in complication rates, lengths of hospital stay or stone-free rates.
Conclusions: Our findings suggest that favourable PCNL outcomes may be expected where access is obtained by either a urologist or an IR, assuming that they have received the appropriate training and that they are skilled and proficient in the procedure.
(© 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.)

Keywords: access; interventional radiologist; outcomes; percutaneous nephrolithotomy; urologist

Date Created: 20170222 Date Completed: 20170630 Latest Revision: 20220321

20231215

10.1111/bju.13817

28220589