Access Related Complications During Percutaneous Nephrolithotomy: Urology Versus Radiology at a Single Academic Institution

Abstract

A recent survey revealed that only 11% of urologists performing percutaneous nephrolithotomy routinely obtained percutaneous access themselves. Reasons for this trend may include lack of training, comfort level and perceived need for radiological involvement. In this study we evaluated percutaneous access for percutaneous nephrolithotomy obtained by interventional radiologists or a urologist at a single academic institution, and compared access trends and complications. Two cohorts of patients who had undergone percutaneous nephrolithotomy between 1999 and 2003 were reviewed. Percutaneous access was performed by a group of interventional radiologists (group 1) or a urologist (group 2). An access difficulty score was calculated using patient, stone and procedural variables. Primary outcome measures of percutaneous access complications such as bleeding, failure of access, pneumothorax or other organ injury were compared between groups. Secondary outcome measures of stone-free rates were also compared. In groups 1 and 2, 54 and 49 patients were identified with a total number of tracts of 54 and 60, respectively. Both groups had similar rates of supracostal access. Mean access difficulty scores were similar between groups. Access related complications were significantly higher in the radiology access group (15 vs 5). Stone-free rates were significantly better in the urology access group (86% vs 61%). Despite similar access difficulty between groups, access related complications were less and stone-free rates were improved during urologist acquired percutaneous access. Urologists instructed in percutaneous access may be able to provide improved stone-free rates during percutaneous nephrolithotomy while minimizing access related complications.