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Comparison of Access Related Complications: Urologist vs Radiologist Obtained Percutaneous Renal Access.
Johann P. Ingimarsson, MD, Rachel A. Moses, MD, Elizabeth B. Johnson, MD, Vernon M. Pais, Jr., MD.
Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.

BACKGROUND:
Percutaneous renal access (PRA) is the cornerstone to successful percutaneous renal surgery (PRS). Unfortunately, this critical step is relegated to interventional radiologists (IR) in 75-90%. Perception that IR possess improved skills has been cited as rationale for this practice pattern. However, few domestic and no regional studies have compared incidence of PRA-related complications between IR and urologists.
METHODS:
288 patients undergoing PRS at an academic center between 2005 and 2012 were retrospectively reviewed. PRA was obtained by a group of fellowship-trained IR (group 1, n=120) or a fellowship-trained endourologist (group 2, n=168) Complications were compared between groups including significant bleeding, transfusion, angioembolization, hydrothorax/pneumothorax, UPJ disruptions and failed access.
RESULTS:
Mean patient age was 52±15 years and 56±16 years in groups 1 and 2. Overall, PRA- related complications occurred in 11.7% and 7.7% in groups 1 and 2 (p = 0.06). No statistical difference was detected between groups in any sub-category of PRA-related complications, including significant bleeding (5.8% vs 5.4%), transfusion (2.5% vs 1.8 %), angioembolization ( 2.5% vs 1.2%), hydrothorax (1.7% vs 2.4%) and failed access (2.5% vs 0%). One death from hemorrhage with multi-organ failure and one UPJ disruption with subsequent obstruction occurred in group 1.
CONCLUSIONS:
We report one of the largest domestic and the first regional comparison of IR and urologist PRA. No statistically significant difference was identified, although there was a trend towards reduced complications in the urology group. We dispel a misperception and confirm that PRA may be safely obtained by urologists in a centralized stone program.


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