Comparison of urologist- and radiologist-gained percutaneous renal access during PCNL: a review

Abstract

Percutaneous renal access for percutaneous nephrolithotomy (PCNL) can be performed by either an interventional radiologist or urologist, depending on local expertise. We reviewed the current literature comparing the success and complications in gaining percutaneous access for both groups. An extensive literature search was carried out using Medline which included keywords “PCNL”, “PCNL access”, “percutaneous nephrolithotomy” and “percutaneous nephrostomy”. The search yielded six published articles that compared the success and complication rates between urologist- and radiologist-performed percutaneous access for PCNL. A systematic literature review was performed. Because of the considerable heterogeneity between studies, no pooling of data or statistical analysis was undertaken. In terms of success or complication rates, there was no significant difference between urologist- and radiologist-made percutaneous tracts. We observed, however, that there appears to be an argument that urologists are in a better position to make their own tracts, which requires only a single-stage procedure in theatre. There appears to be low uptake amongst urologists with the common beliefs that it is a radiological procedure, that radiologists have superior equipment, that it increases intraoperative time and that a steep learning curve is required for proficiency, suggesting that competence in percutaneous access would require at least 60 PCNL procedures. It is therefore unsurprising that many trainees may struggle to gain sufficient exposure to this technique, unless they are training in a centre with adequate patient numbers. Nonetheless, the papers reviewed illustrate that the urologists who are practicing this procedure are performing to an acceptably high standard. In conclusion there appears to be no difference in complication rates between the urologist- and the radiologist-made percutaneous tract. The steep learning curve required can be addressed by new teaching methods such as inanimate simulators, virtual-reality (VR) simulators, PCNL workshops and old-fashioned apprenticeships. A prospective study comparing urologist- and radiologist-placed nephrostomies would be beneficial.