Access Related Complications During Percutaneous Nephrolithotomy: Urology Versus Radiology at a Single Academic Institution

Watterson, James; Soon, Shawn; Jana, Kunal

doi:10.1016/s0022-5347(06)00489-7

Cited by 144 publications

(74 citation statements)

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“…When PCA is performed by the urologist rather than the interventional radiologist, PCNL outcomes are better [13]. In addition, competency in PCA allows urologists to be independent from interventional radiologists in terms of the time and place of obtaining the PCA.…”

Section: Discussionmentioning

confidence: 99%

Is there a place for virtual reality simulators in assessment of competency in percutaneous renal access?

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Is there a place for virtual reality simulators in assessment of competency in percutaneous renal access?

et al. 2015

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“…PC access performed by a radiologist is a practical option, often employed. However, PC access related complications are fewer and stone-free rates are higher with urologist-acquired access (3,13).…”

Section: Commentsmentioning

confidence: 99%

Development of a computer assisted gantry system for gaining rapid and accurate calyceal access during percutaneous nephrolithotomy

Zarrabi

Conradie

et al. 2010

Int. braz j urol.

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Purpose: To design a simple, cost-effective system for gaining rapid and accurate calyceal access during percutaneous nephrolithotomy (PCNL). Materials and Methods:The design consists of a low-cost, light-weight, portable mechanical gantry with a needle guiding device. Using C-arm fluoroscopy, two images of the contrast-filled renal collecting system are obtained: at 0-degrees (perpendicular to the kidney) and 20-degrees. These images are relayed to a laptop computer containing the software and graphic user interface for selecting the targeted calyx. The software provides numerical settings for the 3 axes of the gantry, which are used to position the needle guiding device. The needle is advanced through the guide to the depth calculated by the software, thus puncturing the targeted calyx. Testing of the system was performed on 2 target types: 1) radiolucent plastic tubes the approximate size of a renal calyx (5 or 10 mm in diameter, 30 mm in length); and 2) foam-occluded, contrast-filled porcine kidneys. Results: Tests using target type 1 with 10 mm diameter (n = 14) and 5 mm diameter (n = 7) tubes resulted in a 100% targeting success rate, with a mean procedure duration of 10 minutes. Tests using target type 2 (n = 2) were both successful, with accurate puncturing of the selected renal calyx, and a mean procedure duration of 15 minutes. Conclusions: The mechanical gantry system described in this paper is low-cost, portable, light-weight, and simple to set up and operate. C-arm fluoroscopy is limited to two images, thus reducing radiation exposure significantly. Testing of the system showed an extremely high degree of accuracy in gaining precise access to a targeted renal calyx.

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“…1 Furthermore, in a retrospective single centre study comparing complications of urologist-directed versus interventional radiologist-directed PCA for patients undergoing PCNL, there were significantly lower complications and higher stone-free rates whenever the PCA was performed by the urologist. 2 However, the learning curve of PCNL is quite long. It is reported that 36 to 45 cases are needed to achieve competency and 105 to 115 cases to achieve proficiency.…”

Section: Introductionmentioning

confidence: 99%

Assessment of percutaneous renal access skills during Urology Objective Structured Clinical Examinations (OSCE)

Noureldin

Elkoushy

Andonian

2015

CUAJ

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Introduction: The first objective was to assess percutaneous renal access (PCA) skills of urology postgraduate trainees (PGTs) during the Objective Structured Clinical Examinations (OSCEs). The second objective was to determine whether previous experience with percutaneous nephrolithotomy (PCNL) improved performance. Methods: After obtaining ethics approval, we recruited PGTs from two urology programs in Quebec between postgraduate years (PGY-3 to PGY-5). Each trainee was asked to answer a short questionnaire regarding previous experience in endourologic procedures. After a 3-minute orientation on the PERC Mentor simulator (Simbionix, Cleveland, OH), each trainee was asked to perform task 4, where they had to correctly access all of the renal calyces and pop the balloons in a normal left kidney model. We collected and analyzed data from the questionnaire and the performance report generated by the simulator. Results: In total, 13 PGTs participated in this study. PGTs had performed a median of 200 (range: 50-1000) cystoscopies, 50 (range: 10-125) TURBTs, 30 (range: 0-100) TURPs, 5 (range: 0-50) laser prostatectomies, and 50 (range: 2-125) ureteroscopies prior to this OSCE. PGTs with previous PCNL experience (8/13) had performed a mean of 18.6 ± 6.3 PCNLs. PGTs with previous PCNL experience performed significantly better in terms of shorter fluoroscopy time (10 ± 1.5 vs. 5.1 ± 0.7 min; p = 0.04), fewer attempts required for successful puncture of the pelvi-calyceal system (PCS) (21 ± 2.3 vs. 13 ± 1.8; p = 0.02), and had significantly lower complications in terms of fewer infundibular injury (7.4 ± 1.5 vs. 2 ± 0.4; p = 0.004) and fewer PCS perforations (11 ± 1.7 vs. 4.5 ± 1.2; p = 0.01). Conclusion: It is feasible to use the PERC Mentor simulator during OSCEs to assess PCA skills of urology PGTs. PGTs who had previous PCNL experience performed significantly better with fewer complications.

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Access Related Complications During Percutaneous Nephrolithotomy: Urology Versus Radiology at a Single Academic Institution

Cited by 144 publications

References 10 publications

Is there a place for virtual reality simulators in assessment of competency in percutaneous renal access?

Is there a place for virtual reality simulators in assessment of competency in percutaneous renal access?

Development of a computer assisted gantry system for gaining rapid and accurate calyceal access during percutaneous nephrolithotomy

Assessment of percutaneous renal access skills during Urology Objective Structured Clinical Examinations (OSCE)

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