To compare the PERC-tic technique, described as placement of dual wires under fluoroscopic guidance adjacent to the stone within the obstructed calyx, to standard percutaneous nephrolithotomy (PCNL) with working wires secured down the ureter.
This is a retrospective cohort study of patients who underwent a PCNL procedure between October 2016 and November 2018. Patients undergoing the perc-tic technique were compared to patients undergoing standard PCNL. Regression models evaluated if PERC-tic PCNL was associated with equivalent stone-free rates to standard PCNL at 90 days, need for secondary procedures, and 90-day hospital readmission.
This study involved 126 PCNL cases of which 63 were done using the PERC-tic technique and 63 with standard PCNL. In multivariate analysis, there was no statistical difference in 90-day stone-free rate between standard PCNL and PERC-tic cohorts (p=0.08). We did note a 6 times higher likelihood of needing secondary procedures for residual stones in the PERC-tic versus standard PCNL groups (71% vs 30% p< 0.0001). There was no statistical significance in 90-day hospital readmission rates between groups (p=0.47).
Our findings suggest similar stone free rate at 90 days and higher rates of secondary procedures after PERC-tic PCNL compared to the standard approach; however, there was no difference in complications. These findings may reflect decreased visualization with the PERC-tic technique or simply be reflective of the case difficulty requiring the use of the PERC-tic technique. These findings can be used for patient counseling when considering this technique for complex stone disease.
Urology. 2020 Feb 17 [Epub ahead of print]
Naveen Krishnan, Tim Large, Crystal Valadon, Amy Krambeck
From Indiana University Department of Urology. Electronic address: ., From Indiana University Department of Urology. Electronic address: ., Louisville School of Medicine. Electronic address: ., From Indiana University Department of Urology. Electronic address: .