MP30-14 UPPER POLE UROLOGIST-OBTAINTED PERCUTANEOUS RENAL ACCESS FOR PCNL IS SAFE AND EFFICACIOUS

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy III1 Apr 2015MP30-14 UPPER POLE UROLOGIST-OBTAINTED PERCUTANEOUS RENAL ACCESS FOR PCNL IS SAFE AND EFFICACIOUS Amar Patel, Don Bui, John Pattaras, and Kenneth Ogan Amar PatelAmar Patel More articles by this author , Don BuiDon Bui More articles by this author , John PattarasJohn Pattaras More articles by this author , and Kenneth OganKenneth Ogan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.596AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Interventional radiologist may be hesitant to obtain upper pole access for percutaneous nephrolithotomy (PCNL) due to a higher complication rate. Renal access gained by a urologist may achieve higher stone-free rates with similar complication rates. We discuss our institution's contemporary results of percutaneous renal access in the upper pole for nephrolithotomy by a urologist. We believe that urologist-obtained upper pole access for PCNL is both safe and efficacious. METHODS We performed a retrospective chart review of PCNL performed by a fellowship-trained endourlogist from 2003 to 2014 at a single institution. The inclusion criteria included patients in which renal access was obtained by the urologist via the upper pole for subsequent nephrolithotomy. Variables analyzed include age, gender, BMI, ASA, operative time, rib level, initial stone size, change in hemoglobin (hgb), length of stay (LOS), and post-operative complications. Stone-free status was determined by either KUB or CT scan on post-operative day (POD) #1. Patients without stones visible on KUB or stones less than 4 mm on CT were considered stone-free. RESULTS A total of 144 renal units were percutaneously accessed via the upper pole for subsequent nephrolithotomy. Baseline demographics included, mean age of 52.7 years, 51 males, 93 females, mean BMI of 29.7, median ASA of 3, mean Hgb change on POD #1 of 1.8 g/dL, and a mean hospital stay of 2.5 days. There were a total of 53 (36.8%) stones classified as a staghorn calculi, or which 35 (24.3%) were partial staghorn stones. Renal access was obtained above 11th rib in 12.5% (n=18), above 12th rib in 57.6% (n=83), subcostal in 14.6% (n=21) and undetermined in the rest. Complications were seen in 18 (12.5%) of patients. Hydropneumothorax requiring chest tube was seen in 8 (4.9%) of patients. Postoperative imaging confirmed 93 (64.6%) patients stone-free, and 35 (24.3%) required a second look PCNL. CONCLUSIONS Our experience with upper pole percutaneous renal access for nephrolithotomy has shown that it has an acceptable complication risk. There is an increased chance of thoracic complications but this can be mitigated with technical maneuvers. It should be a part of an endourologist armamentarium who operate on large burden, complex stones or ureteral pathology. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e352 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amar Patel More articles by this author Don Bui More articles by this author John Pattaras More articles by this author Kenneth Ogan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...