Abstract No. 572 Renal access for repeat percutaneous nephrolithotomy in patients with recurrent kidney stones: feasibility, safety and endourologic procedure outcomes

Abstract

We evaluated the feasibility and safety of renal access, and surgical outcomes in patients with recurrent kidney stones who underwent repeat percutaneous nephrolithotomy (PCNL) and compared those in PCNL-naïve patients. Between April 2012 and December 2016, 158 kidneys in 150 patients (73 male, median age: 55 years) were percutaneously accessed for PCNL. Of these, 24 kidneys (11.3%) in 21 patients were accessed for repeat PCNL for recurrent kidney stones (Repeat group). The rest of the 134 kidneys in 129 patients were PCNL-naïve (Naïve group). A stone-bearing calyx was generally accessed at the urologist’s request. Among the repeat group, 18 kidneys (75.0%) were accessed through a previously accessed calices. Technical success rates of renal access (overall and through a stone-bearing calyx), fluoroscopy time (minutes), and incidence of complications related to renal access which resulted in cancellation of same-day PCNL were compared between groups. Stone clearance (no residual stones > 5 mm on post-PCNL imaging) and incidence of complications related to PCNL were also compared. The overall technical success rate of renal access between groups were not significantly different (95.8% (23/24) vs (97.7% (131/134), P = 0.29). However, renal access through a stone-bearing calyx was significantly less achieved in the repeat group than the naïve group (82.6% (19/23) vs 94.9% (112/118), P = 0.05). No statistical difference in mean fluoroscopy time (10.4 vs 10.6, P = .49) and incidence of access-related complications (9.5% vs 5.4%, P = .52) were seen between groups. The complications included infection (2/24 vs 6/134, P = 0.35), bleeding (3/134, P = 0.61) and others (n = 2 in the PCNL naïve group). No statistical difference in stone clearance rate (63% vs 60%, P = .78) and incidence of PCNL-related complications (19.0% vs 24.8%, P = .72) were seen between groups. Renal access for repeat PCNL was feasible without significant difference in incidence of complications or fluoroscopy time compared to that for first-time PCNL. Access through a previously accessed stone-bearing calyx was also feasible, but carried a higher technical failure rate than that of PCNL naïve.