Feasibility and Efficacy of Intermediate-Supine Percutaneous Nephrolithotomy: Initial Experience

Abstract

We evaluated the feasibility and efficacy of intermediate-supine percutaneous nephrolithotomy (PCNL) in patients with renal calculi. Fifteen patients were included in this study. The intermediate-supine operative position was modified by using a 1-L saline bag below the ipsilateral upper flank. A nephrostomy and stone extraction were performed as usual. After completion of the stone removal, a nephrostomy tube was used when necessary according to the surgeon's decision. If there was no significant bleeding or renal pelvic injury, tubeless PCNL was performed. The mean stone size was 5.48±5.69 cm2, the mean operative time was 78.93±38.72 minutes, and the mean hospital stay was 2.60±1.29 days. Tubeless PCNL was performed in 13 cases (86.7%), and retrograde procedures were simultaneously performed without a change of position in 2 patients (ureteroscopic ureterolithotomy in one patient and transurethral placement of an occlusion catheter in one patient). There were two complications according to the Clavien-Dindo classification (Grade I in one patient and Grade II in one patient). The success rate was 80.0% and the complete stone-free rate was 73.3%. Three patients with a significant remnant stone were also successfully managed with additional procedures (one patient underwent a second-look operation, and the remaining two patients were treated with shock wave lithotripsy). In the treatment of renal calculi, intermediate-supine PCNL may be a safe and effective choice that offers several advantages with excellent outcomes. Thus, a prospective study with a larger population is needed to verify our outcomes.

Observational prospective study for surgical outcome and anesthetic feasibility of tubeless and totally tubeless supine PCNL: A single centre initial experience

“…Other studies reported mean operative times ranging between 67.1±19.2 and 78.93±3.8 minutes with tubeless supine PCNL. [20,21] In our study (Table 4) only 2 (3.7%) patients received blood transfusion which is comparable to available literature indicating requirement for blood transfusion in 2.5-4% of the relevant patients. [12,20] Regarding Two (3.7%) patients developed complication of perinephric collection which was managed conservatively.…”

Intraoperative and postoperative feasibility and safety of total tubeless, tubeless, small-bore tube, and standard percutaneous nephrolithotomy: a systematic review and network meta-analysis of 16 randomized controlled trials

“…Anesthesiologists prefer the supine position because of better airway control during procedures. Another advantage of the supine position is that there is no need for position changes when performing additional endoscopic procedures, such as cystoscopic or ureteroscopic operations [ 38 ]. Endoscopic combined intrarenal surgery is also a novel way of performing PCNL in the supine position [ 39 ].…”

An Observational Pilot Study on Supine Percutaneous Nephrolithotomy: Initial Experience at a Single-Centre

“…In our study, the mean (SD) operative time was 91.33 (6.40) minutes (range: 80-105 minutes). Chung et al reported a mean operative time of 78.93 +/- 3.8 minutes [ 10 ]. De Sio et al reported a mean operative time of 43 minutes (range 25-120 minutes) [ 11 ].…”