Endoscopic-guided Versus Fluoroscopic-guided Renal Access for Percutaneous Nephrolithotomy: A Comparative Analysis - 31/01/13

Doi : 10.1016/j.urology.2012.10.004

Wahib Isac ^a, Emad Rizkala ^a, Xiaobo Liu ^b, Mark Noble ^a, Manoj Monga ^a,^⁎
^a Glickman Urological and Kidney Institute Cleveland Clinic, Cleveland, OH
^b Quantitative Health Sciences Department, Cleveland Clinic, Cleveland, OH

Reprint requests: Manoj Monga, M.D., Stevan B. Streem Center for Endourology and Stone Disease, Glickman Urological and Kidney Institute, The Cleveland Clinic Foundation, 9500 Euclid Ave/Q10-1, Cleveland, OH 44195.

Abstract

Objective

To evaluate the intraoperative outcomes of percutaneous renal access using fluoroscopic-guided access (FGA) vs endoscopic-guided access (EGA).

Methods

A retrospective record review was conducted of patients undergoing percutaneous nephrolithotomy (PCNL), categorized by the method of achieving renal access. Patients were randomly assigned to 1 of 2 endourologists: 1 practicing EGA and the other practicing FGA. Patient demographics, baseline characteristics, and operative and postoperative outcomes were compared using univariate and multivariate analysis.

Results

From August 2010 to January 2012, 159 patients underwent PCNL (40% EGA, 60% FGA). No significant difference was observed between groups in age (P = .06), American Society of Anesthesiologists Physical Status Classification (P = .7), number of stones (P = .058), cumulative stone diameter (P = .051), number of calyces involved (P = .82), and stone density (P = .49). Body mass index (BMI) was higher in patients undergoing EGA (P = .013). Patients undergoing EGA had shorter fluoroscopy time (3.2 vs 16.8 minutes, P <.001) and lower access number (1.03 vs 1.22 P = .002). Fluoroscopy time was longer for FGA than for EGA after adjusting for BMI, staghorn stones, and access number (P <.001). No significant difference was noted in change in hemoglobin, blood transfusion rate, operative time, or intraoperative complications between groups. Procedures were aborted due to bleeding more commonly in the FGA (8%) than in the EGA group (0%, P = .02) A secondary procedure for stone management was required in 2 (3.2%) of the EGA group compared with 12 (12.5%) of the FGA group.

Conclusion

EGA is safe and effective and leads to decreased fluoroscopy time, decreased need for multiple accesses, and decreased risk of early termination of the procedure or need for secondary procedures.

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