Percutaneous nephrolithotomy in the supine position: Safety and outcomes in a single-centre experience

Abstract

ObjectivesTo assess the feasibility of performing percutaneous nephrolithotomy (PCNL) with the patient supine. Although PCNL with the patient prone is the standard technique for treating large (>2 cm) renal stones including staghorn stones, we evaluated the safety and efficacy of supine PCNL for managing large renal stones, with special attention to evaluating the complications.Patients and methodIn a prospective study between January 2010 and December 2011, 54 patients with large and staghorn renal stones underwent cystoscopy with a ureteric catheter inserted, followed by puncture of the collecting system while they were supine. Tract dilatation to 30 F was followed by nephroscopy, stone disintegration using pneumatic lithotripsy, and retrieval using a stone forceps. All patients had a nephrostomy tube placed at the end of the procedure. The results were compared with those from recent large series of supine PCNL.ResultsThe median (range) operative duration was 130 (90–210) min, and the mean (SD) volume of irrigant was 22.2 (3.7) L. One puncture was used to enter the collecting system in 51 renal units (94%), while three units (6%) with a staghorn stone needed two punctures. The stone clearance rate was 91%, and five patients had an auxiliary procedure. There were complications in 15 patients (28%). All patients were stone-free at a 3-month follow-up.ConclusionSupine PCNL is technically feasible; it has several advantages to patients, urologists and anaesthesiologists. It gives stone-free rates and a low incidence of organ injury comparable to those in standard prone PCNL.

Supine versus prone PCNL in lower calyceal stone: Comparative study in a tertiary care center

“…8,14 Nour et al in his study found that three patients out of 54 renal unit undergoing PCNL in supine position needed an auxiliary endoscopic procedure under anaesthesia. 15 We have seen that two patients in each group of supine and prone PCNL further require second relook PCNL.…”

Ultrasound guidance can be used safely for renal tract dilatation during percutaneous nephrolithotomy

“…Only the modified dorsal lithotomy position was a statistically significant predictor of ultrasound tract dilatation. While some have demonstrated that fluoroscopic access is feasible and safe in the supine position, our practice is to use ultrasound or simultaneous ureteroscopic visualization to guide tract access and dilatation when in this position. This particular association is most likely a reflection of practice pattern and illustrates the utility of ultrasound and direct‐vision tract dilatation when the patient is supine.…”

Percutaneous nephrolithotomy: implementation of digital insertion and dissection as an adjunct to the technique

“…[12][13] In the supine position, the risk of perforation of the colon (0.5%) is lower because the intestine floats freely in the abdomen away from the kidney. 14 Compared with single access, multiple access entails an increased risk of bleeding and complications, including a detrimental effect on renal function. 15 The digital insertion and dissection technique does not cause problems for the movement of the access sheath or leakage of saline solution with its instillation during the procedure, nor is bleeding modified.…”