Mp25-13 percutaneous access for percutaneous nephrolithotomy achieved by urologists early in the learning curve is safe

You have accessJournal of UrologyCME1 Apr 2023MP25-13 PERCUTANEOUS ACCESS FOR PERCUTANEOUS NEPHROLITHOTOMY ACHIEVED BY UROLOGISTS EARLY IN THE LEARNING CURVE IS SAFE Nizar Hakam, Gregory Hosier, Xavier Cortez, Fadl Hamouche, Leslie Charondo, Heiko Yang, Carter Chan, Kevin Chang, Wilson Sui, Justin Ahn, David Bayne, Marshall Stoller, and Thomas Chi Nizar HakamNizar Hakam More articles by this author , Gregory HosierGregory Hosier More articles by this author , Xavier CortezXavier Cortez More articles by this author , Fadl HamoucheFadl Hamouche More articles by this author , Leslie CharondoLeslie Charondo More articles by this author , Heiko YangHeiko Yang More articles by this author , Carter ChanCarter Chan More articles by this author , Kevin ChangKevin Chang More articles by this author , Wilson SuiWilson Sui More articles by this author , Justin AhnJustin Ahn More articles by this author , David BayneDavid Bayne More articles by this author , Marshall StollerMarshall Stoller More articles by this author , and Thomas ChiThomas Chi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003253.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Use of percutaneous nephrolithotomy (PCNL) is now standard for stones larger than 20 mm by the American Urological Association guidelines. Achieving percutaneous access is a critical step of successful PCNL, and it is important for urologists to learn this skill to provide patients with the highest quality stone care. We aimed to assess clinical outcomes in PCNL cases in which access was achieved by trainees versus attending physicians to examine whether access obtained by surgeons early in their learning curve was safe. METHODS: Prospectively collected data from the Registry for Stones of the Kidney and Ureter (ReSKU) was reviewed for all patients who underwent PCNL at a single center between 2015 and 2021. The level of expertise of the surgeon acquiring access was recorded in all cases and categorized as obtained by the resident, fellow, or attending physician. Stone characteristics were analyzed; stone burden was calculated using maximal summative diameter. Primary outcomes were Clavien-Dindo post-operative complications and stone free status. Univariate statistics were used to compare outcomes between Group 1 (cases where access was achieved by a trainee (resident or fellow)) and Group 2 (cases where access was achieved by an attending). RESULTS: 256 PCNL cases with follow-up data were included in the analysis. Percutaneous access was obtained by a trainee in 147 (57.4%) cases and by an attending physician in 109 (42.6%) cases. Median stone burden was 29 mm (IQR 16 – 48 mm) and 32.4% of stones were Guy complexity score 3 or 4. Comparison of stone and patient characteristics is demonstrated in Table 1. Cases in Group 1 had a smaller median stone size and shorter operative time. Patient positioning and use of fluoroscopy (52.4% ultrasound only in group 1 vs 48.6% in Group 2) were similar between groups. Stone free status was not statistically different between groups (61.9% in group 1 vs 73.4% in group 2, p=0.48), but there were more Clavien-Dindo 2A complications in Group 2 (6.1% in group 1 vs 16.5% in group 2) (p=0.014). CONCLUSIONS: Percutaneous access achieved by trainees earlier in their learning curve compared to experienced attending surgeons appears to be safe. These data support the idea that with careful patient selection, urologists can safely acquire this important surgical skill. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e347 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nizar Hakam More articles by this author Gregory Hosier More articles by this author Xavier Cortez More articles by this author Fadl Hamouche More articles by this author Leslie Charondo More articles by this author Heiko Yang More articles by this author Carter Chan More articles by this author Kevin Chang More articles by this author Wilson Sui More articles by this author Justin Ahn More articles by this author David Bayne More articles by this author Marshall Stoller More articles by this author Thomas Chi More articles by this author Expand All Advertisement PDF downloadLoading ...