Presented by: Daniel Marchalik MD, MBA
MedStar Georgetown University Hospital

Introduction

Radiation exposure from percutaneous nephrolithotomy (PCNL) can vary widely between institutions and surgeons. The purpose of this study was to compare radiation exposure (fluoroscopy time and dose) during PCNL when renal access is obtained by interventional radiology (IR) versus urology.

Materials

A retrospective chart review was conducted of consecutive patients undergoing unilateral PCNL, categorized by the method of renal access, by three endourologists from January 2020 to January 2023. Two of the endourologists use IR assistance to obtain renal access prior to PCNL while the other endourologist performed PCNL with endoscopic combined intrarenal surgery (ECIRS). Patient characteristics along with fluoroscopy times, fluoroscopy doses, and operative times were compared using a two-independent sample student’s t-test and multivariable linear regression analysis.

Results

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Thirty-one patients underwent unilateral PCNL with IR renal access (group 1 (IR)) while 66 patients underwent urology-guided ECIRS (group 2 (URO)). The two groups were similar based on mean age, BMI, sex, and stone size. Fluoroscopy dose (39.6 vs. 327 mgy, p <0.001) and fluoroscopy time (1.46 vs. 10.9 min, p <0.001) were significantly lower in the URO group. Total operative time (1.97 vs. 3.00 hours, p <0.001) was also lower in the URO group. With each unit increase in BMI, fluoroscopy dose was increased by 28.93 mgy (p<0.001) in the IR group. However, this correlation was not noted in the URO group.

Conclusion

Endoscopic guided renal access by a urologist resulted in a significant reduction in radiation exposure and operative time. Interestingly, BMI was associated with increased operative times within the IR renal access group, but not the urology renal access group. As these patients are likely to undergo multiple procedures requiring fluoroscopy and given the negative potential effects of radiation exposure, it is important to continue to find ways to decrease total radiation dose in percutaneous urologic surgery.

Funding

none

Lead Authors

Kenneth Lim, MD
MedStar Georgetown University Hospital

Sarah Fashakin, BS
Georgetown University School of Medicine

Dar Yoffe, BS
Georgetown University School of Medicine