title: Evaluation of Renal Function after Percutaneous Nephrolithotomy-Does the Number of Percutaneous Access Tracts Matter?
abstract: Renal function following percutaneous nephrolithotomy has long been a concern to urologists, especially in the setting of multi-tract access. We determined whether the risk of renal injury after multi-tract percutaneous nephrolithotomy was greater than after a single access approach.
  
  
  
  We retrospectively reviewed the records of 307 consecutive patients treated with percutaneous nephrolithotomy from 2011 to 2012 at Wake Forest Health. Perioperative (99m)Tc-mercaptoacetyltriglycine nuclear renogram parameters along with serum creatinine values were assessed within 1 year of the procedure. Patients were stratified by single access vs multi-access (2 or more).
  
  
  
  We identified 110 cases in which renography was done before and after percutaneous nephrolithotomy. A total of 74 patients (67.3%) underwent single access percutaneous nephrolithotomy while 36 (32.7%) underwent multi-access percutaneous nephrolithotomy. Serum creatinine did not significantly differ between the 2 cohorts postoperatively (p = 0.09). There was a significant 2.28% decrease in renal function based on mercaptoacetyltriglycine nuclear renogram results after percutaneous nephrolithotomy of the affected kidney in patients with multiple accesses (p <0.01). This relationship was not observed when patients were stratified by multiple comorbidities associated with nephrolithiasis.
  
  
  
  Multi-access percutaneous nephrolithotomy is associated with a small reduction in the function of the targeted kidney compared to a single access approach.
authors.affiliation: Department of Urology, Wake Forest Baptist Medical Center, Winston Salem, North Carolina; Department of Urology, University of Alabama (DGA), Birmingham, Alabama.
authors.forename: Ilya
authors.initials: I
authors.lastname: Gorbachinsky
authors.affiliation: Department of Urology, Wake Forest Baptist Medical Center, Winston Salem, North Carolina; Department of Urology, University of Alabama (DGA), Birmingham, Alabama.
authors.forename: Kyle
authors.initials: K
authors.lastname: Wood
authors.affiliation: Department of Urology, Wake Forest Baptist Medical Center, Winston Salem, North Carolina; Department of Urology, University of Alabama (DGA), Birmingham, Alabama.
authors.forename: Marc
authors.initials: M
authors.lastname: Colaco
authors.affiliation: Department of Urology, Wake Forest Baptist Medical Center, Winston Salem, North Carolina; Department of Urology, University of Alabama (DGA), Birmingham, Alabama. Electronic address: shemal@wakehealth.edu.
authors.forename: Sij
authors.initials: S
authors.lastname: Hemal
authors.affiliation: Department of Urology, Wake Forest Baptist Medical Center, Winston Salem, North Carolina; Department of Urology, University of Alabama (DGA), Birmingham, Alabama.
authors.forename: Jayadev
authors.initials: J
authors.lastname: Mettu
authors.affiliation: Department of Urology, Wake Forest Baptist Medical Center, Winston Salem, North Carolina; Department of Urology, University of Alabama (DGA), Birmingham, Alabama.
authors.forename: Majid
authors.initials: M
authors.lastname: Mirzazadeh
authors.affiliation: Department of Urology, Wake Forest Baptist Medical Center, Winston Salem, North Carolina; Department of Urology, University of Alabama (DGA), Birmingham, Alabama.
authors.forename: Dean G
authors.initials: DG
authors.lastname: Assimos
authors.affiliation: Department of Urology, Wake Forest Baptist Medical Center, Winston Salem, North Carolina; Department of Urology, University of Alabama (DGA), Birmingham, Alabama.
authors.forename: Jorge
authors.initials: J
authors.lastname: Gutierrez-Aćeves
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053040:Nephrolithiasis / Q000601:surgery*; D000074642:Nephrolithotomy, Percutaneous / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D051437:Renal Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: kidney; nephrolithiasis; nephrostomy, percutaneous; radioisotope renography; technetium TC 99m mertiatide