title: Safe and effective obtainment of access for percutaneous nephrolithotomy by urologists: the Louisiana State University experience.
abstract: OBJECTIVE
  Access for percutaneous nephrolithotomy (PCNL) is critical to successful removal of stone burden and is often performed by a specialist other than a urologist. In many regions, however, there is limited availability of such personnel. We reviewed the complication rates that were related to PCNL access when performed at a teaching hospital to establish that access for PCNL may be safely taught to and performed by urology residents. Chief urology residents across the nation were also anonymously surveyed to better understand the current trends and dynamics regarding PCNL access in teaching institutions.
  
  
  METHODS
  A retrospective chart review was performed of all PCNLs performed at our institution from 1995 to 2009 for any complications that were related to surgery. Patients with access gained at outside institutions or not attempted at the time of surgery by residents were excluded. The complication rate was compared with those of the American College of Radiology. An eight-question survey was also sent by e-mail to all current urology chief residents regarding their experience with PCNL access during residency.
  
  
  RESULTS
  A total of 290 patients underwent PCNL with 338 separate access sites gained at the time of surgery under the supervision of nine teaching staff. Access was gained in all cases at the time of surgery. Major complications included: Transfusion in 20 (5.9%) patients, sepsis in 2 (0.6%) patients, pseudoaneurysm necessitating intervention in 2 (0.6%) patients, hydrothorax in 2 (0.6%) patients, pneuomothorax in 1 (0.3%) patient, ureteropelvic junction disruption in 1 (0.3%) patient, and one death (0.3%) after surgery. Minor complications included: Urinary tract infection in five (1.5%) patients, and collecting system injuries in 6 (1.8%) patients necessitating placement of a ureteral stent. Our survey of residents demonstrated that 53% did not routinely gain access for PCNL at their institution. The 94% who did not get instruction on PCNL access, however, thought it would be a valuable addition to their training.
  
  
  CONCLUSIONS
  Our results show that access for PCNL surgery can be safely and successfully obtained by genitourinary residents under the supervision of trained staff at the time of surgery. We think that access for PCNL is a valuable tool that should be in the armamentarium of all urologic surgeons on leaving an accredited urology training program.
authors.affiliation: Department of Urology, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71103, USA. Asmi14@lsuhsc.edu
authors.forename: Alison
authors.initials: A
authors.lastname: Spann
authors.forename: Jason
authors.initials: J
authors.lastname: Poteet
authors.forename: Dustin
authors.initials: D
authors.lastname: Hyatt
authors.forename: Leah
authors.initials: L
authors.lastname: Chiles
authors.forename: Rowena
authors.initials: R
authors.lastname: Desouza
authors.forename: Dennis
authors.initials: D
authors.lastname: Venable
mesh_terms: D005471:Fluoroscopy; D006801:Humans; D007430:Intraoperative Care; D008145:Louisiana; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects* / Q000379:methods*; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery; D010820:Physicians; D011183:Postoperative Complications / Q000209:etiology; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome; D014495:Universities; D014572:Urology