Renal Access by Sonographer versus Urologist during Percutaneous Nephrolithotomy

Purpose: To evaluate the percutaneous access outcomes and complications following percutaneous nephrolithotomy (PCNL) that was obtained by sonographer or urologist at a single academic institution. Material and Methods: A retrospective chart review of 259 patients who underwent PCNL was performed. Patients were stratified according to percutaneous access by sonographer (group 1) or urologist (group 2) in 174 and 85 patients, respectively. Demographic, stone characteristics, operative variables, percutaneous access complications and stone-free rates were compared between groups. Results: The major complication rate and minor complication rate, mean blood loss and rates of blood transfusion were comparable between groups. Compared with urologist, sonographer preferred to choose subcostal rib puncture instead of intercostal rib puncture. The lower calyx was the most frequent site of target calyx puncture in group 1 (165 cases, 94.8%), while the percentage of lower calyx in group 2 was 82.3% (72 cases) (P = .001). The overall stone-free rates were significantly higher in group 2 than that in group 1 (90.6% vs. 79.9%, P = .03). In group 1, 23 cases (13.2%) needed post-operative extracorporeal shock wave lithotripsy (SWL), while, the percentage of post-operative SWL in group 2 was only 4.7% (4 cases) (P = .035). Conclusions: Renal access in PCNL can be safely and successfully obtained by both sonographer and urologist. Infracostal and lower calyx access in our study has poor stone-free rates and sonographer prefers infracostal and lower access. We encourage urologists establish renal access by themselves during PCNL.