Percutaneous Nephrolithotomy Access: A Meta-Analysis Comparing Access by Urologist vs Radiologist.

Percutaneous nephrolithotomy is a minimally invasive procedure indicated for the management of staghorn calculi or renal calculi larger than 2.0 cm. Percutaneous renal access is a critical step in this procedure and can be performed by either urologists or interventional radiologists. The purpose of this study is to perform a meta-analysis to compare outcomes between urologist and interventional radiologist mediated access.

An electronic literature search was conducted to identify studies comparing urologist and interventional radiologist acquired access. Studies must have included both urologist and intervention radiologist acquired access data, but were excluded if (1) not in English; (2) abstract without full text; (3) unable to determine who acquired access; (4) only included either urologist or interventional radiologist data. Meta-analysis comparison was generated with the Review Manager 5.4 software.

After screening the abstracts and title, 55 relevant studies were identified. Nine articles were utilized in the meta-analysis. Urologist acquired access was associated with a greater stone free rate (RR=1.10; 95% CI, 1.01, 1.20), a reduction in major complications (RR=0.69; 95% CI, 0.53, 0.92), and a shorter hospital stay (mean difference -0.40; 95% CI, -0.64, -0.16) in comparison to radiologist acquired access. Urologist acquired access was associated with greater blood loss (mean difference 0.46; 95% CI, 0.32, 0.60) when compared to interventional radiology acquired access. No significant differences were found with regards to unusable access, multiple tracts, supracostal access, ancillary procedure requirement, operative time, minor complications, and transfusions.

Urologist acquired access may be associated with a higher stone free rate and a reduction in major complications, whereas interventional radiologist mediated access may be associated with a reduction in blood loss, despite similar transfusion rates.

Journal of endourology. 2022 Sep 22 [Epub ahead of print]

Joshua Ghoulian, Alex Nourian, Zafardjan Dalimov, Eric Ghiraldi, Justin I Friedlander

Loma Linda University Medical Center, Urology, Loma Linda, California, United States., Albert Einstein Healthcare Network, Urology, Philadelphia, Pennsylvania, United States; ., Albert Einstein Healthcare Network, Department of Urology, Philadelphia, Pennsylvania, United States; ., Albert Einstein Healthcare Network, Urology, 1200 Tabor Road, 3rd Floor, Philadelphia, Pennsylvania, United States, 19141-3098; ., Albert Einstein Healthcare Network, Urology, Philadelphia, Pennsylvania, United States.

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