Comparison of radiation exposure for interventional radiology vs urology-guided renal access for percutaneous nephrolithotomy

Introduction: Radiation exposure during percutaneous nephrolithotomy (PCNL) can vary depending on the method used for renal access. This study aimed to compare fluoroscopy time and dose during PCNL when renal access is achieved via interventional radiology (IR) versus urology.

Methods: A retrospective review of patients who underwent unilateral PCNL between January 2020 and February 2023 was conducted. Patients were categorized by renal access method: endoscopic combined intrarenal surgery performed by a urologist (ECIRS) or IR-assisted. A Wilcoxon rank-sum test and multivariate analyses were done to compare several parameters of the two groups.

Results: 66 patients underwent ECIRS (group 1), and 31 underwent IR-assisted access (group 2). The groups were similar in age, BMI, sex, and stone size. The difference in medians for fluoroscopy dose, fluoroscopy time, operative time and length of stay were statistically significant (p < 0.001). Average fluoroscopy dose (39.6 vs. 327 mGy) and time (1.46 vs. 10.9 min), along with average operative time (1.97 vs. 3.00 h) and length of stay (1.26 vs 3.06 days) were all lower in group 1. In the IR group, a positive correlation was noted between BMI and fluoroscopy dose (p < 0.001), though this correlation was absent with ECIRS.

Conclusions: PCNL with ECIRS access significantly reduces radiation exposure and operative time compared to IR-assisted access. Additionally, BMI influenced radiation exposure and operative time in the IR group, but not in the ECIRS group. Endoscopic renal access may lower overall radiation exposure and postoperative complications.