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Does Imaging Modality Used for Percutaneous Renal Access Make a Difference? A Matched Case Analysis

Andonian, Sero ; Scoffone, Cesare M. ; Louie, Michael K. ; Gross, Andreas J. ; Grabe, Magnus LU ; Daels, Francisco P. J. ; Shah, Hemendra N. and de la Rosette, Jean J. M. C. H. (2013) In Journal of Endourology 27(1). p.24-28
Abstract
Objective: To assess perioperative outcomes of percutaneous nephrolithotomy (PCNL) using ultrasound or fluoroscopic guidance for percutaneous access. Methods: A prospectively collected international Clinical Research Office of the Endourological Society (CROES) database containing 5806 patients treated with PCNL was used for the study. Patients were divided into two groups based on the methods of percutaneous access: ultrasound versus fluoroscopy. Patient characteristics, operative data, and postoperative outcomes were compared. Results: Percutaneous access was obtained using ultrasound guidance only in 453 patients (13.7%) and fluoroscopic guidance only in 2853 patients (86.3%). Comparisons were performed on a matched sample with 453... (More)
Objective: To assess perioperative outcomes of percutaneous nephrolithotomy (PCNL) using ultrasound or fluoroscopic guidance for percutaneous access. Methods: A prospectively collected international Clinical Research Office of the Endourological Society (CROES) database containing 5806 patients treated with PCNL was used for the study. Patients were divided into two groups based on the methods of percutaneous access: ultrasound versus fluoroscopy. Patient characteristics, operative data, and postoperative outcomes were compared. Results: Percutaneous access was obtained using ultrasound guidance only in 453 patients (13.7%) and fluoroscopic guidance only in 2853 patients (86.3%). Comparisons were performed on a matched sample with 453 patients in each group. Frequency and pattern of Clavien complications did not differ between groups (p = 0.333). However, postoperative hemorrhage and transfusions were significantly higher in the fluoroscopy group: 6.0 v 13.1% (p = 0.001) and 3.8 v 11.1% (p = 0.001), respectively. The mean access sheath size was significantly greater in the fluoroscopy group (22.6 v 29.5F; p < 0.001). Multivariate analysis showed that when compared with an access sheath <= 18F, larger access sheaths of 24-26F were associated with 3.04 times increased odds of bleeding and access sheaths of 27-30F were associated with 4.91 times increased odds of bleeding (p < 0.05). Multiple renal punctures were associated with a 2.6 odds of bleeding. There were no significant differences in stone-free rates classified by the imaging method used to check treatment success. However, mean hospitalization was significantly longer in the ultrasound group (5.3 v 3.5 days; p < 0.001). Conclusions: On univariate analysis, fluoroscopic-guided percutaneous access was found to be associated with a higher incidence of hemorrhage. However, on multivariate analysis, this was found to be related to a greater access sheath size (>= 27F) and multiple punctures. Prospective randomized trials are needed to clarify this issue. (Less)
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; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Endourology
volume
27
issue
1
pages
24 - 28
publisher
Mary Ann Liebert, Inc.
external identifiers
  • wos:000313582200008
  • scopus:84872301398
  • pmid:22834999
ISSN
0892-7790
DOI
10.1089/end.2012.0347
language
English
LU publication?
yes
additional info
The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Urology (013243400), Pediatrics/Urology/Gynecology/Endocrinology (013240400)
id
a00a585b-1c3c-49b9-aa07-9fc358b148cb (old id 3470674)
date added to LUP
2016-04-01 11:01:02
date last changed
2020-09-09 01:50:32
@article{a00a585b-1c3c-49b9-aa07-9fc358b148cb,
  abstract     = {Objective: To assess perioperative outcomes of percutaneous nephrolithotomy (PCNL) using ultrasound or fluoroscopic guidance for percutaneous access. Methods: A prospectively collected international Clinical Research Office of the Endourological Society (CROES) database containing 5806 patients treated with PCNL was used for the study. Patients were divided into two groups based on the methods of percutaneous access: ultrasound versus fluoroscopy. Patient characteristics, operative data, and postoperative outcomes were compared. Results: Percutaneous access was obtained using ultrasound guidance only in 453 patients (13.7%) and fluoroscopic guidance only in 2853 patients (86.3%). Comparisons were performed on a matched sample with 453 patients in each group. Frequency and pattern of Clavien complications did not differ between groups (p = 0.333). However, postoperative hemorrhage and transfusions were significantly higher in the fluoroscopy group: 6.0 v 13.1% (p = 0.001) and 3.8 v 11.1% (p = 0.001), respectively. The mean access sheath size was significantly greater in the fluoroscopy group (22.6 v 29.5F; p &lt; 0.001). Multivariate analysis showed that when compared with an access sheath &lt;= 18F, larger access sheaths of 24-26F were associated with 3.04 times increased odds of bleeding and access sheaths of 27-30F were associated with 4.91 times increased odds of bleeding (p &lt; 0.05). Multiple renal punctures were associated with a 2.6 odds of bleeding. There were no significant differences in stone-free rates classified by the imaging method used to check treatment success. However, mean hospitalization was significantly longer in the ultrasound group (5.3 v 3.5 days; p &lt; 0.001). Conclusions: On univariate analysis, fluoroscopic-guided percutaneous access was found to be associated with a higher incidence of hemorrhage. However, on multivariate analysis, this was found to be related to a greater access sheath size (&gt;= 27F) and multiple punctures. Prospective randomized trials are needed to clarify this issue.},
  author       = {Andonian, Sero and Scoffone, Cesare M. and Louie, Michael K. and Gross, Andreas J. and Grabe, Magnus and Daels, Francisco P. J. and Shah, Hemendra N. and de la Rosette, Jean J. M. C. H.},
  issn         = {0892-7790},
  language     = {eng},
  number       = {1},
  pages        = {24--28},
  publisher    = {Mary Ann Liebert, Inc.},
  series       = {Journal of Endourology},
  title        = {Does Imaging Modality Used for Percutaneous Renal Access Make a Difference? A Matched Case Analysis},
  url          = {https://lup.lub.lu.se/search/ws/files/2307109/3631933.pdf},
  doi          = {10.1089/end.2012.0347},
  volume       = {27},
  year         = {2013},
}