Image-Guided Access for Percutaneous Nephrolithotomy: A Single-Center Experience in 591 Patients

Patrick L Vande Lune; David Thayer; Naganathan Mani; Andrew Warren; Alana C Desai; Daniel J Picus; Andrew J Gunn

doi:10.1159/000499304

Image-Guided Access for Percutaneous Nephrolithotomy: A Single-Center Experience in 591 Patients

Curr Urol. 2019 Jul;12(4):210-215. doi: 10.1159/000499304. Epub 2019 Jul 20.

Authors

Patrick L Vande Lune¹, David Thayer², Naganathan Mani², Andrew Warren², Alana C Desai³, Daniel J Picus², Andrew J Gunn¹

Affiliations

¹ Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama, Birmingham, AL.
² Division of Vascular and Interventional Radiology, Mallinckrodt Institute of Radiology.
³ Department of Urology, Washington University, St. Louis, MO, USA.

Abstract

Introduction: We present our experience in image-guided percutaneous nephrolithotomy (PCNL) access in 591 patients.

Materials and methods: An IRB-approved review of all adult PCNL cases from 2009 to 2014 was performed. Patient data, information regarding stone size and location, procedural details, clinical success, complications by access site (upper pole versus middle or lower pole) and puncture location (supracostal versus infracostal) were recorded.

Results: In this study, 591 patients (314 males, 278 females, mean stone size: 23 mm, range: 4-100 mm) were included. Stone clearance was achieved in 66% of patients. There were 174 total complications (29.3%). Upper pole access was less likely to require a secondary access to achieve stone clearance (p = 0.02) and was preferentially used for both larger stones (p = 0.006) and staghorn calculi (p = 0.001). If a supracostal approach to the upper pole was used, there were significantly more complications compared to an infracostal approach (p = 0.002).

Conclusion: Upper pole access for PCNL provides anatomic advantages for stone clearance but significantly increases the risk for complications when a supracostal puncture is required.

Keywords: Interventional radiology; Nephrolithiasis; Nephrolithotomy.