title: Impact of percutaneous renal access technique on outcomes of percutaneous nephrolithotomy.
abstract: OBJECTIVE
  Percutaneous nephrolithotomy (PCNL) is regarded as the gold standard for the treatment of patients with renal stones larger than 2 cm in diameter. Creating a percutaneous renal access is the initial and probably the most important step in performing a PCNL. Two primary methods of obtaining proper percutaneous renal access under fluoroscopic guidance are described: The "triangulation" and the "eye of the needle" techniques. In this article, we compare these two techniques in terms of success and complication rates.
  
  
  METHODS
  From October 2010 to May 2011, 80 patients with simple renal stones were prospectively randomized into two groups according to the percutaneous renal access technique used for PCNL. Patients in group 1 (n=40) were assigned to the eye of the needle technique, and patients in group 2 (n=40) were assigned to the triangulation method. Patients needing multiple access points were excluded from the study. The preoperative, operative, and postoperative follow-up findings were thereafter analyzed and compared.
  
  
  RESULTS
  No significant difference between the two groups was detected in terms of patient demographics (mean patient age, body mass index, stone size, or stone location). The operation time, fluoroscopic screening time (FST), and duration of hospitalization were similar in both groups (P=0.52, P=0.32, P=0.26, respectively). Patients in group 1 had a larger drop in hematocrit postoperatively than patients in group 2 (7.6 ± 3.7 vs 4.8 ± 2.1, P=0.001). The blood transfusion rate (7.5%) was similar in both groups, however. Although the complication rate was higher in group 1 than group 2, no significant difference was detected (20% vs 15%, P=0.76).
  
  
  CONCLUSIONS
  The present study demonstrates that PCNL can be performed safely using two different percutaneous access techniques. The two techniques studied in this trial had similar FSTs, operation and hospitalization times, success rates, and complication rates.
authors.affiliation: Department of Urology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey. akadirtepeler@yahoo.com
authors.forename: Abdulkadir
authors.initials: A
authors.lastname: Tepeler
authors.forename: Abdullah
authors.initials: A
authors.lastname: Armağan
authors.forename: Tolga
authors.initials: T
authors.lastname: Akman
authors.forename: Emre Can
authors.initials: EC
authors.lastname: Polat
authors.forename: Cevper
authors.initials: C
authors.lastname: Ersöz
authors.forename: Ramazan
authors.initials: R
authors.lastname: Topaktaş
authors.forename: Mehmet Remzi
authors.initials: MR
authors.lastname: Erdem
authors.forename: Sinasi Yavuz
authors.initials: SY
authors.lastname: Onol
mesh_terms: D000328:Adult; D003710:Demography; D005260:Female; D006801:Humans; D007668:Kidney / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D019990:Perioperative Care; D011182:Postoperative Care; D016896:Treatment Outcome