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

OBJECTIVE: 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). METHODS: 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. RESULTS: 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/m(2) and male gender of 63.8%. The mean stone size was 618.4 ± 47.0 mm(2) 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). CONCLUSION: PCNLs with pre-formed PCA were associated with significantly lower FT and EBL when compared with PCNLs without pre-formed PCA.