Current practices in percutaneous nephrolithotomy among endourologists

Abstract

Objective: To characterize current practices of percutaneous nephrolithotomy (PCNL) among endourologists in relation to practice setting, experience, and fellowship training.

Methods: An Internet survey was administered to active Endourological Society members. Responses were grouped based on demographic information pertaining to setting of practice, number of years practiced, and fellowship training in endourology. PCNL technique details were evaluated and compared by each group. Statistical analysis was performed using SPSS.

Results: Two hundred ninety-three completed responses of 2000 were received. There was a significant difference in the experience level among respondents (p < 0.001), with a relatively greater proportion being 11-20 years in practice. The majority of respondents were academic urologists (74%), with 18% being within a group-based private practice. Seventy-seven percent of respondents obtained their own access while 19% had access by interventional radiologists. Sixty-two percent were endourology fellowship trained, and fellows were significantly more likely to obtain their own access (82% vs 71%, p=0.022). Eighty-six percent used the prone position to obtain access, 10% used supine, and 4% used lateral decubitus. An antegrade approach was preferred by 68%, while 18.5% used a retrograde, and 12% used a combined approach. Overall, 76% placed a nephrostomy tube for postoperative drainage; a ureteral stent or catheter was placed in 28% or 11% of respondents, respectively, and only 6 respondents (2%) performed a "tubeless" procedure without any drainage.

Conclusions: The majority of Endourological Society members performing PCNLs who responded obtain their own access, and there is a higher proportion of self-obtained access in fellowship-trained endourologists. Prone positioning is predominant, and more than 75% of respondents leave a nephrostomy tube postoperatively, underscoring that the tubeless approach is rare.