Presented by: T. Max Shelton MD
Indiana University School of Medicine

Introduction

Percutaneous nephrolithotomy (PCNL) is indicated for the treatment of large renal calculi. At our institution, percutaneous access into the kidney is performed by urologists the majority of the time, however, in some instances, patients already have a percutaneous nephrostomy (PCN) tube placed by interventional radiology (IR) prior to the PCNL surgery. This study aimed to evaluate outcomes of PCNLs in patients with pre-existing nephrostomy tubes and focused on pre-existing PCN tract utilization versus new urology-obtained intraoperative access.

Materials

A retrospective study was performed to identify patient who underwent unilateral PCNL with preoperative nephrostomy tube placement by interventional radiology at a single institution from 2017 to 2022. Patient demographic data, surgical outcomes and 30-day postoperative data was analyzed. 

Results

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A total of 79 patients met inclusion criteria. In 63 patients (79.7%), the existing nephrostomy access was used to perform PCNL, while in 16 (20.3%) patients new intraoperative access was obtained. No differences were noted in postoperative stent or nephrostomy tube placement, residual stone burden, same-day discharge rate, or ipsilateral secondary surgery at 90 days. 30-day complication rates and emergency department visits were higher in the PCN tract set at 29 (46.03%) vs 1 (6.25%).

Conclusion

Our findings reveal a statistically significant increase in the 30-day complication rate when the PCN tract was reused compared to when new intraoperative access was obtained (46% vs. 6.3%, respectively). This observation suggests a potential advantage in establishing new intraoperative access during PCNL in patients with a pre-existing nephrostomy tubes. Further studies are warranted to substantiate these results and to identify the underlying factors responsible for the increased complication rate. 

Funding

None

Co-Authors

Kameron Bell,
Indiana University School of Medicine

Nicholas Crowe,
Indiana University School of Medicine

William Stanton,
Indiana University School of Medicine

RJ Caras, DO
Indiana University School of Medicine

Austen Slade, MD
Indiana University School of Medicine

Marcelino Rivera, MD
Indiana University School of Medicine