Patient positioning during percutaneous nephrolithotomy: what is the current best practice?

Mourmouris, Panagiotis; Berdempes, Marinos; Markopoulos, Titos; Lazarou, Lazaros; Tzelves, Lazaros; Skolarikos, Andreas

doi:10.2147/rru.s174396

Cited by 12 publications

(7 citation statements)

References 49 publications

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“…However, effect of patient position on cardiopulmonary complications during PCNL is conflicting and these is no clear evidence on what constitutes the best clinical practice. Nevertheless, to overcome such problems, researchers have advocated supine or lateral decubitus positioning, use of conscious sedation, and awake endotracheal intubation with prone patient self-positioning ( 45 ). Mazzucchi et al ( 46 ) have compared outcomes of supine and prone PCNL in obese patients only to find no difference in clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Effect of Body Mass Index on Outcomes of Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis

Huang

2022

Front. Surg.

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ObjectiveThe current study aimed to assess the efficacy and safety of percutaneous nephrolithotomy (PCNL) in obese and overweight individuals based on body mass index (BMI).MethodsWe electronically explored the databases of PubMed, CENTRAL, ScienceDirect, Embase, and Google Scholar databases for all types of comparative studies investigating the role of BMI on PCNL outcomes. Only studies defining obesity as >30 kg/m2 were included. Efficacy outcomes were stone-free rates and operating time while safety outcomes were complications and length of hospital stay (LOS).ResultsEighteen studies with 101,363 patients were included. We noted no difference in the stone-free rates after PCNL for morbid obese vs normal BMI patients (OR: 0.78 95% CI, 0.57, 1.08 I2 = 7% p = 0.13), overweight vs normal (OR: 1.01 95% CI, 0.89, 1.15 I2 = 1% p = 0.83) and obese vs normal patients (OR: 1.00 95% CI, 0.87, 1.16 I2 = 0% p = 0.95). PCNL operative time was significantly increased in morbid obese (MD: 9.36 95% CI, 2.85, 15.88 I2 = 76% p = 0.005) and obese patients as compared with normal patients (MD: 2.15 95% CI, 1.20, 3.10 I2 = 0% p < 0.00001), but not for overweight patients. There was no difference in the odds of complications between morbid obese vs normal (OR: 1.26 95% CI, 0.93, 1.72 I2 = 0% p = 0.13), overweight vs normal (OR: 1.11 95% CI, 0.96, 1.28 I2 = 0% p = 0.15), and obese vs normal patients (OR: 1.07 95% CI, 0.91, 1.27 I2 = 0% p = 0.40). LOS was significantly reduced in obese patients (MD: −0.12 95% CI, −0.20, −0.04 I2 = 0% p = 0.004) as compared to normal patients, but not for morbid obese or overweight patients.ConclusionPCNL has similar efficacy and safety in morbidly obese, obese, and overweight patients as compared to normal BMI patients with no difference in the stone-free and complication rates. Evidence suggests that operating time is increased in morbidly obese and obese patients and the latter may have shorter LOS.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier: CRD42022313599.

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Section: Discussionmentioning

confidence: 99%

Effect of Body Mass Index on Outcomes of Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis

Huang

2022

Front. Surg.

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“…Hemodynamic changes were associated with body position changes, as it has been previously referred in the field of anesthesia when adopting the PD position [1][2][3][4]16,17 . These changes reflect heart preload and afterload alterations.…”

Section: Discussionmentioning

confidence: 99%

“…This position is commonly used in medical-surgical procedures, such as nephrolithotomy 1 , endoscopic retrograde cholangiopancreatography 2 , and in posterior fossa surgeries of the head, neck, vertebrae, retroperitoneum, and posterior body structures in case of plastic surgery 3,4 .…”

Section: Introductionmentioning

confidence: 99%

Feasibility in the echocardiographic estimation of parameters of the right ventricle in prone position

Santos-Martínez

Mendoza-Copa

García‐Cruz

et al. 2020

ACME

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Background: Echocardiographic cardiac parameters in the prone position are usually obtained with an esophageal probe. The feasibility of obtaining them by means of a transthoracic approach is unknown. Objective: Estimating the feasibility to obtain parameters of the right ventricle by transthoracic echocardiography in prone position on the subject. Methods: Pilot design of consecutive case series without cardiopulmonary disease. Demographic, vital signs and echocardiographic variables were defined in the ventral initial, prone and ventral final decubitus positions. The data are shown with averages and standard deviations, and frequencies and percentages according to the variable. The differences between the positions were calculated with ANOVA of repeated samples and adjustment of Bonferroni test. Intra-subject variability was obtained by the Bland-Altman procedure and its 95% confidence interval. Results: We studied 50 subjects, 44 (88%) males, age 30 ± 6 years and body mass index 25.65 ± 2.71 kg/m 2 . Tricuspid annular plane systolic excursion (TAPSE) and S'-wave were measured 100% of the time. The vital signs and echocardiographic variables according to the position had differences in:

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“…Los cambios hemodinámicos estuvieron relacionados con los cambios de posición corporal, como se ha referido previamente en el ámbito de la anestesia al adoptar la posición de DP [1][2][3][4]16,17 . Estos traducen alteraciones en la precarga y la poscarga al corazón.…”

Section: Discussionunclassified

“…Esta posición es de uso común en procedimientos medicoquirúrgicos, como en la nefrolitotomía 1 , colangiopancreatografía retrograda endoscópica 2 y en cirugías de fosa posterior de la cabeza, cuello, vértebras, retroperitoneo y estructuras posteriores del cuerpo ante cirugía plástica 3,4 .…”

Section: Introductionunclassified

Factibilidad en la estimación ecocardiográfica de parámetros del ventrículo derecho en posición prono

Santos-Martínez¹,

Mendoza-Copa²,

García-Cruz³

et al. 2020

ACM

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Introducción: Los parámetros cardiacos ecocardiográficos en posición de decúbito prono usualmente se obtienen con sonda esofágica. Se desconoce la factibilidad de obtenerlos mediante aproximación transtorácica. Objetivo: Estimar la factibilidad para obtener parámetros del ventrículo derecho mediante ecocardiografía transtorácica en el sujeto en posición de decúbito prono. Métodos: Diseño piloto de serie de casos consecutivos sin enfermedad cardiopulmonar. Se acotaron variables demográficas, signos vitales y ecocardiográficas en posición decúbito ventral inicial, prono y ventral final. Los datos se muestran con promedios y desviaciones estándar, y frecuencias y porcentajes de acuerdo con la variable. La diferencia entre las posiciones se calculó con ANOVA de muestras repetidas y ajuste de Bonferroni. Se obtuvo la variabilidad intrasujetos mediante el procedimiento de Bland-Altman y su intervalo de confianza al 95%. Resultados: Se estudiaron 50 sujetos, 44 (88%) masculinos, edad 30 ± 6 años e índice de masa corporal 25.65 ± 2.71 kg/m 2 . El TAPSE (excursión sistólica del plano del anillo tricuspídeo) y la onda S' se midieron en el 100% de las veces. Los signos vitales y variables ecocardiográficas de acuerdo con la posición tuvieron diferencias en:

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Patient positioning during percutaneous nephrolithotomy: what is the current best practice?

Cited by 12 publications

References 49 publications

Effect of Body Mass Index on Outcomes of Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis

Effect of Body Mass Index on Outcomes of Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis

Feasibility in the echocardiographic estimation of parameters of the right ventricle in prone position

Factibilidad en la estimación ecocardiográfica de parámetros del ventrículo derecho en posición prono

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