Document Detail


Renal access by urologist or radiologist during percutaneous nephrolithotomy.
MedLine Citation:
PMID:  20919919     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
PURPOSE: We evaluated percutaneous access for percutaneous nephrolithotomy (PCNL) that was obtained by interventional radiologists or urologists at a single academic institution and compared access outcomes and complications.
PATIENTS AND METHODS: The records of 233 patients who underwent PCNL at the University of Pittsburgh Medical Center between 2000 and 2008 were retrospectively reviewed. Patients were stratified according to percutaneous access by urologists (group 1) or a group of interventional radiologists (group 2) in 195 and 38 patients, respectively. Radiologist-acquired access was performed for collecting system decompression in 33.3% of patients in group 2. A predicted access difficulty score was calculated using demographic, stone, and operative variables. Percutaneous access complications and stone-free rates were compared between groups.
RESULTS: Mean patient age was 53 ± 16 years (51% male, range 19-90 y) and 58 ± 17 years (62% male, range 25-95 y) in groups 1 and 2, respectively. Use of multiple access tracts (4.3% vs 5.4%; P = 0.54), mean stone diameter (3.5 ± 1.8 cm vs 3.6 ± 1.9 cm; P = 0.97), and percentage of supracostal tracts (36% vs 35%; P = 0.63) were comparable between groups. Mean access difficulty parameters were comparable between groups. The percentage of staghorn calculi (39% vs 30%; P = 0.28) and number of obese (body mass index > 30) patients (30% vs 38%; P = 0.34) were also comparable between groups 1 and 2. The complication rate was the same in the two groups (14.3% vs 13.5%; P = 0.52). The overall stone-free rate was significantly greater in the urology access group (99% vs 92.1%; P = 0.033) on univariate analysis. Radiologist-obtained access could not be used in 36.8% of patients, necessitating additional access tract placement at the time of surgery.
CONCLUSIONS: Urologist-obtained access is safe and effective for PCNL. Access obtained by radiologists for decompression of infected or obstructed systems often is not adequate for PCNL. Despite similar stone complexity and access difficulty, urologist-obtained access was associated with a statistically significant improvement in overall stone-free rate.
Authors:
Jeffrey J Tomaszewski; Tara D Ortiz; Bishoy A Gayed; Marc C Smaldone; Stephen V Jackman; Timothy D Averch
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Publication Detail:
Type:  Journal Article     Date:  2010-10-04
Journal Detail:
Title:  Journal of endourology / Endourological Society     Volume:  24     ISSN:  1557-900X     ISO Abbreviation:  J. Endourol.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-04     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8807503     Medline TA:  J Endourol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1733-7     Citation Subset:  IM    
Affiliation:
Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA. tomaszewskijj@upmc.edu
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