Minimally Invasive Interventional Radiology Management of Kidney and Ureteral Stones: A Preliminary Experience

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(s)

Khloe Gu, BS

OMS-III
Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

AD

Anthony Andres DePalma, MD

Attending Interventional Radiologist
Emory Vascular and Interventional Radiology
EK

Edward Keshishian, MD

Fellow, Department of Radiology
University of South Florida
GH

Glenn Hoots, MD

Attending
Tampa General Hospital
Bruce Zwiebel, MD

Attending
Radiology Assoc. Of Tampa, Inc.
CE

Chad Engel, MD

Attending
Tampa General Hospital
Nariman Nezami, MD

Attending
University of Maryland School of Medicine
JS

Jamil Shaikh, MD

Assistant Professor
Division of Vascular and Interventional Radiology, Morsani College of Medicine, Tampa General Hospital, University of South Florida

Disclosure(s):

Khloe Gu, BS: No financial relationships to disclose

Nariman Nezami, MD: CAPS Medical: Consultant (Ongoing)

Purpose: Incidence of kidney stones in the United States has been rising over the past two decades, with the current annual cumulative incidence being approximately 1% {1}. Treatment options for renal stones include conservative management, medical therapy, surgical, and percutaneous options {2}. Although percutaneous nephrolithotomy (PCNL) is associated with high stone-free and technical success, complication rate remains high at 20-38% with primary contributing factors including nephrostomy access size, stone location, and method of stone extraction {3}. This preliminary study aims to serve as an introduction on how Interventional Radiologists (IR) can safely and effectively perform minimally invasive percutaneous nephrolithotomy (mPCNL) using a miniaturized scope to remove large renal stones in a single session or staged approach. It also compares the advantages and disadvantages of the workflow of performing IR-driven mPCNL versus standard PCNL.

Materials and Methods:

A multicenter retrospective analysis of prospectively planned cases was performed at two academic centers in the United States between December 2021 and October 2022. A total of 8 patients underwent mPCNL that were performed by four attending interventional radiologists. Patient characteristics, procedural details, and complications were collected. Complications were categorized based on Society of Interventional Radiology adverse event classification. The primary endpoint was defined as successful partial or complete extraction of the renal stone(s).

Results:

All patients except one (7/8, 85.7%) required only one procedure. All procedures achieved 100% (8/8) procedural, technical, and clinical success with no complications observed during or 30-days after the procedure. Significant reduction in time interval between PCN/PCNU placement and removal was seen in mPCNL workflow compared to PCNL (range 4-8 weeks, median 5 weeks in mPCNL vs. 6-16 weeks in PCNL). All procedures were done with moderate sedation in outpatient settings and no patients required inpatient admission after the procedure.

Conclusion: Interventional Radiology-driven renal calculi removal via mPCNL is safe and effective while offering high technical and procedural success rates that are equivalent to standard PCNL with minimal complications. A simplified and streamlined workflow might have greater advantages in settings where anesthesia demand is limited. Overall, mPCNL can offer shorter length hospitalizations, lower risk of complications, and reduced overall healthcare costs.