Kidney displacement in complete supine PCNL is lower than prone PCNL

Abstract

To compare the amount of the kidney displacement in the complete supine percutaneous nephrolithotripsy (PCNL) to the prone PCNL during getting renal access. Thirty-three patients were randomly divided into two groups. The patients in group A were placed in the complete supine position and the patients in group B in the prone position. Amounts of the kidney displacement in three states and other data were analyzed. The mean amount of the kidney displacement in the complete supine PCNL was 10.1 ± 7.9 mm in stage 1, 10.7 ± 8.28 mm in stage 2 and 12.2 ± 10.4 mm in stage 3. The mean amount of the kidney displacement in prone PCNL was 16.6 ± 5.8 mm in stage 1, 16.2 ± 6.3 mm in stage 2 and 17.6 ± 6.7 mm in stage 3. In stages 1 and 2, a significant difference between the two groups derived from the mean amount of the kidney displacement, but the difference was not statistically significant in stage 3. Adjusted for age, gender, BMI, stone burden and position of PCNL, prone position was a predictor caused significantly more displacement in all three stages. Among other predictors, only BMI had a significant effect on the amount of the kidney displacement (in stages 2 and 3). Performing PCNL in the complete supine position is safe and effective and leads to less kidney displacement during getting renal access and therefore, it may be considered in most patients requiring PCNL.

Percutaneous nephrolithotomy in complete supine flank-free position in comparison to prone position: A single-centre experience

“…No patient in either group developed severe sepsis. The slightly better outcome in the supine PCNL group for complications is probably explained by the easy and straightforward puncture leading to less bleeding and renal damage during tract dilatation and manipulation [19] . There were no cases of adjacent visceral injury in either group, whilst Duty et al [20] reported a lower risk of visceral injury in the supine position.…”

Flank-Suspended versus Prone Percutaneous Nephrolithotomy: Changes of Haemodynamics, Arterial Blood Gases and Subjective Feelings

“…They found that the amount of kidney displacement was 10.1 ± 7.9, 10.7 ± 8.28 and 12.2 ± 10.4 mm in the supine group at the indicated time points, significantly lower than that in the prone group with the value being 16.6 ± 5.8, 16.2 ± 6.3 and 17.6 ± 6.7 mm, respectively. It was suggested in their study that supine PCNL possessed advantages over the prone PCNL such as safety, effectiveness and less occurrence of kidney displacement (5). Zhong et al in China also reported that supine PCNL helped monitor the anaesthesia state and could be smoothly completed in most cases with satisfactory outcome achieved (6).…”

How well tolerated is supine percutaneous nephrolithotomy?

“…A study by Falahatkar et al [26] showed more kidney displacement when access is gained in prone position compared with supine position. Gaining access proved to be more difficult with greater kidney displacement.…”