Percutaneous nephrolithotomy training during COVID-19: Progress made with Telemedicine at the university clinic of Urology and Andrology of CNHU-HKM

Abstract

Background: Percutaneous nephrolithotomy is one of the recommended techniques for treating kidney stones. Teleassistance was introduced at the University Clinic of Urology and Andrology of CNHU-HKM following the emergence of COVID-19. It has enabled the continuation of skills transfer to Beninese urologists despite international travel restrictions. This study evaluates its outcomes.

Patients and Methods: A descriptive cross-sectional study of 14 PCNL procedures performed with telementoring over an 8-month period (August 2020 to March 2021) at CNHU-HKM. Variables studied included CT scan characteristics of stones, mentors’ contribution to the mentee, and procedure outcomes.

Results: The mean patient age was 50.82 years (range: 25–69 years). Mentors were located at a minimum distance of 7,000 km (Eastbourne, United Kingdom) and a maximum distance of 11,822 km (Guangzhou, China) from Cotonou. The mean stone size was 20 mm (range: 12–46 mm). Seven patients had stones located in multiple calyces simultaneously. Mentor assistance was requested for renal puncture and dilation in 3 and 4 cases respectively, while their help proved particularly useful for nephroscopy and stone fragmentation in 5 cases for each of these steps. Eight patients achieved stone-free status, while in 6 others, the procedure was either incomplete or unsuccessful.

Conclusion: PCNL remains the reference surgery for large staghorn renal stones and constitutes a demanding procedure. Teleassistance can facilitate training of urologists in developing countries in this technique, particularly during periods of health restrictions.