Urologists are increasingly performing their own initial renal access procedures for percutaneous nephrolithotomy (PCNL), with a corresponding decrease in the proportion of those procedures performed in interventional radiology (IR) departments, according to a recent study.

The proportion of urologists performing their own de novo renal access for PCNL rather than having patients undergo the procedure in an IR department rose from 12.8% in 2007 to 32.3% in 2017, Ian S. Metzler, MD, of the University of Washington School of Medicine in Seattle, and colleagues reported in the Journal of Endourology. Although IR departments performed a shrinking proportion of renal access procedures during the study period, they still performed a greater proportion (40%) of the procedures in 2017 compared with urologists. In 27.7% of PCNL cases in 2017, no provider-assigned renal access CPT code for renal access was available, the investigators noted.

Moreover, compared with urologist-gained access, radiologist-gained access was associated with a significantly greater percentage of patients requiring a hospital stay of more than 2 days (30.8% vs 18.6%) and a significantly higher 90-day rate of hospital readmission (16.7% vs 12.8%), and 90-day blood transfusion rate (0.8% vs 0.3%), according to the investigators.

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“We were encouraged to see that the uptake of urologists obtaining their own access has increased over the last decade and that their outcomes on selected patients were comparable to our IR colleagues,” Dr Metzler told Renal & Urology News. “PCNL remains a lower-volume, but critically important procedure for urologists and continued support for education and training of percutaneous access should be emphasized.” 

The findings are from a study looking at trends in the use of PCNL, ureteroscopy (URS), and extracorporeal shockwave lithotripsy (SWL) during 2007 to 2017. Using the MarketScan insurance claims database, the investigators used CPT codes to identify PCNL, URS, and SWL cases.

During the 10-year study period, the annual proportion of PCNL procedures peaked at 4.5%, with a recent decline in 2016 and 2017 to 3.2%, Dr Metzler’s team reported. While URS use increased steadily from 46.3% to 60.0% of procedures, SWL use decreased from 50.0% to 36.7% of procedures.


Metzler IS, Holt S, Harper JD. Surgical trends in nephrolithiasis: Increase de novo renal access by urologists for percutaneous nephrolithotomy. Published online April 5, 2021. J Endourol. doi:10.1089/end.2020.0888