PD18-04 PCNL ACCESS BY UROLOGIST OR RADIOLOGIST: AN ANALYSIS OF THE BAUS PCNL REGISTRY

INTRODUCTION AND OBJECTIVES: Obtaining percutaneous access to the collecting system of the kidney is fundamental to safe and effective PCNL. Practice varies between countries, hospitals and individual surgeons as to whether access is obtained by a urologist or an interventional radiologist (IR). The objective of this study was to compare outcomes of urologist versus IR tracts using data from the BAUS PCNL data registry. METHODS: Data submitted to the BAUS PCNL data registry between 2009 and 2015 were analysed according to whether access was obtained by a urologist or an IR. We evaluated access success, number and type of tracts, perceived and actual access difficulty, as well as outcomes including stone free rate, length of stay and complications including transfusion rates. Stone complexity was assessed using the Guy’s Stone Score. Two-tailed Fisher’s exact test was used to assess differences between the groups. RESULTS: Overall, percutaneous renal access was undertaken by an IR in 3,453 of 5,211 procedures (66.3%); this rate appeared stable over the entire study period, for all categories of stone complexity and in cases where there was predicted or actual difficulty with access. Only 1% of procedures were abandoned because of failed access and this rate was identical in each group (see Table). IRs did more multiple tracts than urologists (6.8% vs 5.1%, p1⁄40.02) but did similar rates of supracostal punctures (8.2% vs 9.2%, p1⁄40.23). Ultrasound was used more commonly by IRs than urologists (56.6% vs 21.7%, p1⁄40.0001) to guide access. There were no significant differences in complication rates, lengths of stay or stone free rates on Day 1 post-operative imaging. CONCLUSIONS: In the UK most access for PCNL is obtained by an interventional radiologist. There do not appear to be any differences in outcomes of PCNL according to whether access is obtained by a urologist or an interventional radiologist. Our findings suggest that favourable PCNL outcomes may be expected where access is obtained by individuals who have been appropriately trained and who are skilled and proficient in the procedure. However, we believe that a multidisciplinary approach to the management of patients with complex stones may lead to better outcomes.