Does the presence of a percutaneous renal access influence fluoroscopy time during percutaneous nephrolithotomy?

The aim of this study was to assess whether the presence of a pre-formed percutaneous renal access (PCA) had any effects on fluoroscopy time (FT) during percutaneous nephrolithotomy (PCNL). After ethics approval was obtained, medical records of all patients who underwent PCNL between 2009 and 2013 at a tertiary stone referral centre were retrospectively reviewed. Patients with and without pre-formed PCA undergoing PCNL were compared. Patients who underwent second-look PCNL and those who had their access inserted by interventional radiology constituted the group with pre-formed PCA. A total of 185 PCNLs were reviewed. The mean patient age was 55.2 ± 1.0 years with mean body mass index (BMI) of 27.8 ± 0.5 kg/m2 and male gender of 63.8%. The mean stone size was 618.4 ± 47.0 mm2 with mean Guy's grade of 2.3 ± 0.7 and mean S.T.O.N.E. score of 7.6 ± 0.1. The mean operative time was 98.7 ± 2.6 min with mean FT of 113.4 ± 4.5 s. The overall stone-free rate was 71.9% with complication rate of 16.2%. When compared with PCNLs without pre-formed PCA, PCNLs with pre-formed PCA were associated with significantly shorter FT (120.6 ± 5.1 vs. 77.5 ± 6.7 s; p < 0.001) and significantly lower estimated blood loss (EBL) (p = 0.01). On multivariate analysis, PCNLs with pre-formed PCA were associated with significantly shorter FT (B. coefficient = −43.2 (95%CI: −66.4 to −20); p < 0.001) and lower EBL (p = 0.02). PCNLs with pre-formed PCA were associated with significantly lower FT and EBL when compared with PCNLs without pre-formed PCA.