Presentation Authors: David Mikhail*, Zachary Kozel, Luke Griffiths, David Hoenig, Arthur Smith, Zeph Okeke, New Hyde Park, NY
Introduction: Advancements in technology and indications have made PCNL (Percutaneous Nephrolithotomy) a more accessible and common treatment for nephrolithiasis worldwide. Although a reasonably safe procedure, PCNL still has a 10-15% complication rate â€“ most being minor complications. Major complications such as visceral organ injury, although rare, do occur & can be fatal. Our institution is a high volume center with a fellowship training program. We sought to investigate the international communityâ€™s experience with rare complications and evaluate the effect of training & experience on their management.
Methods: We developed an anonymous 26 question survey distributed via the Endourological Society e-mail list. The survey included questions on respondent demographics, training history, experience, practice, surgical technique, rare complications & their management. The complications of interest were splenic, liver and colonic injury. Data was analyzed using SPSS (IBM, 2017). Fisherâ€™s exact & Chi-squared tests were used to assess colonic injury management. Goodman & Kruskalâ€™sÂ Î»Â was used to determine whether the diagnosis and management of splenic and liver complications could be predicted by practice level, previous training and annual PCNL volume.
Results: A total of 323/2000 members began the survey (response rate 16%), with a completion rate of 89% (n=288). Respondents were mostly academic (59%), from North America (36%) or Europe (16%) & had 10+ years of independent practice (63%). About 40% performed 20-60 PCNLs per year, while 26% did < 20 per year. In terms of training â€“ only 42% had done fellowship training in PCNL, while almost half (43%) of respondents reported no formal PCNL courses or training. When asked about injuries at their institution over the past 15 years â€“ respondents recalled 36 splenic, 39 liver & 133 colonic injuries. Current practice level was predictive of splenic injury management & time of diagnosis (p < 0.05), while number of PCNLs performed per year was predictive of diagnosis & management of all three injuries (p < 0.05). Interestingly, the most common complication (colonic injury) was more appropriately managed by fellowship trained urologists â€“ 27.3% vs. 13.9% (p < 0.05).
Conclusions: As PCNL becomes more common worldwide â€“ urologists must appropriately recognize & manage potentially fatal complications. Our results show that experience and formal training lead to improved recognition and management of visceral complications during PCNL. As volume during post-graduate training continue to decrease â€“ formal endourology training might be necessary for safe PCNL practices.