Renal Access by Urologist or Radiologist for Percutaneous Nephrolithotomy—Is it Still an Issue?

El‐Assmy, Ahmed; Shokeir, Ahmed A.; Mohsen, Tarek; El‐Tabey, Nasr; El-Nahas, Ahmed R.; Shoma, Ahmed M.; Eraky, Ibrahim; El-Kenawy, Mahmoud R.; El‐Kappany, Hamdy A.

doi:10.1016/j.juro.2007.05.015

Cited by 75 publications

(60 citation statements)

References 19 publications

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“…Only 11% of urologists routinely perform percutaneous puncture without the assistance of a radiologist (5). Access obtained by interventional radiologists is comparable to that obtained by urologists, but additional studies have shown that the stone-free rate is higher and access-related complications were less frequent when access is obtained by a urologist (5,11,12). This difference in rates may be because urologists aim to obtain direct access into a renal calyx to reach the stone, whereas radiologists often place percutaneous access for drainage only.…”

Section: Discussionmentioning

confidence: 99%

Contemporary Trends in Percutaneous Nephrolithotomy in the United States: 1998-2011

Stern

Tyson

Abdul-Muhsin

et al. 2016

Urology

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Section: Discussionmentioning

confidence: 99%

Contemporary Trends in Percutaneous Nephrolithotomy in the United States: 1998-2011

Stern

Tyson

Abdul-Muhsin

et al. 2016

Urology

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“…This is despite the fact that the literature shows that urologist-directed percutaneous nephrostomy placement is very safe and effective with failure rates and complications rates comparing favourably with radiology colleagues. 1,5,6 This novel set up has resulted in several improvements to the service we offer patients as well as providing increased exposure for our trainees to renal ultrasound and percutaneous nephrostomy placement. Although we acknowledge the numbers of nephrostomies and anterograde stents we have performed is still relatively small, the experience gained by our trainees in these procedures is invaluable and not available readily in other urology departments to our knowledge.…”

Section: Discussionmentioning

confidence: 99%

“…This is despite good evidence that urologists can safely and effectively obtain percutaneous renal access with comparable outcomes to radiologists. 1 Radiologists also carry out numerous nephrostograms and nephrostomy removals under fluoroscopy in patients with concurrent JJ stents to avoid the stent being inadvertently displaced. This is a heavy burden on interventional radiology lists, which are already oversubscribed.…”

mentioning

confidence: 99%

‘An interventional urology list’ – a novel concept for UK urological services

Masood

Ismail

El‐Husseiny

et al. 2011

annals

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Almost all patients in the UK presenting to urologists and other specialities with obstructed and/or infected kidneys are referred to interventional radiologists for percutaneous nephrostomy and/or placement of an antegrade JJ stent. This is despite good evidence that urologists can safely and effectively obtain percutaneous renal access with comparable outcomes to radiologists.1 Radiologists also carry out numerous nephrostograms and nephrostomy removals under fluoroscopy in patients with concurrent JJ stents to avoid the stent being inadvertently displaced. This is a heavy burden on interventional radiology lists, which are already oversubscribed. Furthermore, septic patients with obstructive uropathy sometimes end up in an intensive care unit often with poor outcome, whilst waiting to be transferred to a hospital with an interventional radiology department if one is not available on site. This is an increasing problem with hospital mergers and split-site hospital trusts.Although this tradition is going strong in the UK, urologists throughout the world have evolved their practice to encompass such interventional procedures in their remit. This is because renal ultrasonography and percutaneous renal intervention, forms an integral part of their residency training. Urological tract ultrasound training has only recently been introduced as part of the syllabus in higher surgical training in urology in the UK.2 However, this may be difficult to implement effectively as the infrastructure is not yet in place to train British urology trainees in ultrasound. It is clear to many of us that very few urology trainees get exposure to renal ultrasound. This important issue should be addressed by the British Association of Urological surgeons (BAUS) in conjunction with the Royal College of Radiologists (RCR).At our centre, endourology trainees have access to an ultrasound scanner in our clinics where they receive super- We have set up a local anaesthetic list 'interventional urology list' in our ESWL suite. We present our 4-year experience and discuss the benefits that this interventional list brings to our patients, our trainees, our interventional radiology colleagues and to the hospital trust. PATIENTS AND METHODS From May 2005 to May 2009, we have been running this list, twice-weekly, performing procedures such as nephrostomies, anterograde stents, nephrostograms and stent exchanges all under local anaesthetic. RESULTS A total of 580 procedures have been carried out on this list over this period. Our success rate for nephrostomy insertion is 96% with three failures, as a result of patient discomfort. No major complications and three minor complications were reported. We had four failed anterograde stenting procedures (out of 80). All other procedures including nephrostograms, stent exchanges/removals/insertions, as well as renal cyst aspiration and sclerotisation were successfully carried out. CONCLUSIONS Our results of percutaneous nephrostomy and antegrade stenting are favourable when compared with published data on n...

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“…With numerous previous studies, pre-and peri-operative factors such as stone size and configuration, percutaneous access number and location, entry performed by radiologist or urologist, presence of hydronephrosis have been investigated as predictors of success rates and complications [4][5][6][7][8][9][10]. Attempts to identify the associated variables showed variations among the results which has made it difficult to classify the patients so that the stone free rate (SFR) or complications can be predicted.…”

Section: Introductionmentioning

confidence: 99%

Predicting Surgical Outcome of Percutaneous Nephrolithotomy: Validation of the Guy’s Stone Score and Nephrolithometric Nomogram in Terms of Success and Complications

Eğilmez¹

2015

Ann Clin Anal Med

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ÖzetAmaç: Tek merkezden retrospektif olarak yapılan bu çalışmanın amacı, Guy taş skoru ve nefrolithometrik nomogram kabiliyeti ile PCNL başarısının ön-görülmesi ve gözlemlenen komplikasyonların skorlama sistemleri ile değer-lendirilmesinin validasyonunun yapılmasıdır. Gereç ve Yöntem: PCNL ameliyatı uygulanan 1646 yetişkin hastanın medikal kayıtları gözden geçirilmiştir. Gerekli kriterleri sağlayan 1325 hasta çalışmaya dahil edilmiştir. İstatistiksel analiz için gerekli olan veriler hastaların medikal kayıtlarından elde edilmiş-tir. Bulgular: Gözlemlenen komplikasyonlarla ve başarı ile anlamlı korelasyonunun bulunduğu tek preoperatif, operatif ve postoperatif değişken taş yü-küdür (p<0,05). Guy taş skoru 1 ve 2, başarı ile ilişkili iken, skor 3 ve 4 komplikasyonlarla ilişkilidir (p<0,05). ASA skor 3 ve 4'ün komplikasyonlar ile ilişkili olduğu gözlenmiştir (p<0,05). Ameliyat süresi >120 dakika, staghorn taş varlığı, peroperatif ve postoperatif kan transfüzyonu, nefrostomi kataterinin sü-resi, 2 gr/dL'den fazla ΔHg ve postoperatif kan/idrar kültüründe üreme olması gözlemlenen komplikasyonlar ile ilişkili diğer değişkenlerdir (p<0,05). Nefrolithometrik nomogram verileri ile yapılan ROC eğrisi analizi, başarı eşik değeri %80,5 ile, nomogramın sensitivitesinin %71 ve spesitivitesinin %74 olduğunu göstermiştir (ROC AUC=%80). Nomogramın gözlenen komplikasyon için daha ileri analizinde ise olası bir komplikasyonun öngörülebilmesi için yeterince güçlü ilişki bulunmadığını göstermiştir (ROC AUC=%67). Tartışma: Bu çalışma, nefrolithometrik nomogramın başarı için iyi bir tahmin keskinliğinin bulunduğunu (AUC=0,80) ve Guy taş skorunun başarı ve komplikasyonlarla iyi kore-lasyonunun (p<0,05) bulunduğunu göstermektedir ve ameliyat öncesi değerlendirme-karar vermede kullanılabileceğini göstermektedir. Anahtar KelimelerPerkütan Nefrolithotomi; Guy Taş Skoru; Nefrolitometrik Nomogram Abstract Aim: This single institution retrospective study aims to validate the ability of Guy's stone score and the nephrolithometric nomogram to predict the success of PCNL and to assess the correlation of the scoring systems with the complications encountered. Material and Method: Medical files of 1646 adult patients to whom a PCNL operation was performed were reviewed. A total of 1325 patients fulfilled the needed criteria and were included in the study. Study variables were recorded from the medical files for statistical analysis. Results: Stone burden was the only pre-operative, operative and post-operative variable that had a statistically significant correlation both with success and also with the complications encountered (p<0.05). Guy's stone score grade 1 and 2 were associated with success and grade 3 and 4 were associated with complications (p<0.05). ASA score 3 and 4 were seen to be associated with complications (p<0.05). Operation time >120 minutes, presence of a staghorn stone, intra-and post-operative blood transfusion, duration of the nephrostomy catheter, ΔHg more than 2 gr/dl and and positive post-operative urine/blood culture were ...

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Renal Access by Urologist or Radiologist for Percutaneous Nephrolithotomy—Is it Still an Issue?

Cited by 75 publications

References 19 publications

Contemporary Trends in Percutaneous Nephrolithotomy in the United States: 1998-2011

Contemporary Trends in Percutaneous Nephrolithotomy in the United States: 1998-2011

‘An interventional urology list’ – a novel concept for UK urological services

Predicting Surgical Outcome of Percutaneous Nephrolithotomy: Validation of the Guy’s Stone Score and Nephrolithometric Nomogram in Terms of Success and Complications

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