Prone percutaneous nephrolithotomy: its advantages and our technique for puncture

Carrión, Diego M; Cansino, José R.; Quintana, Luis Miguel; Rivas, Juan Gómez; Rodríguez, J.A. Mainez; Pérez-Carral, J.R.; Martínez‐Piñeiro, Luis

doi:10.21037/tau.2018.10.04

Cited by 13 publications

(9 citation statements)

References 60 publications

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“…La punción se realizó en posición de Valdivia-Galdakao en el 90.0% (20) y en posición prono en el 9.1%. (2) El número de tractos realizados fue unitracto en el 95.5% (21) y bitracto en 4.5%. (1) En el 86.4% se dejó un catéter ureteral doble J (CUDJ) y el 13.6% (3) fue NLPC tubeless.…”

Section: Resultsunclassified

“…(1) El uso del ultrasonido para NLPC se describió por primera en 1976 por Fernstrom y Johansson, desde entonces este procedimiento ha ganado popularidad en la aplicación de nuevos métodos y técnicas. (2) En los últimos años, su popularidad ha crecido con la publicación de múltiples series de casos, lo que demuestra su reproducibilidad, seguridad y eficacia. (3)(4)(5)(6) El enfoque guiado por ultrasonido ha demostrado ser seguro y eficaz en la población pediátrica, (7) para litiasis en los riñones trasplantados y en la ectopia pélvica renal.…”

Section: Introductionunclassified

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Acceso renal guiado por ultrasonido para nefrolitotomía percutánea en un centro de referencia del Sureste de México

Magaña-González

Monzon-Falconi

Cruz-Nuricumbo

2021

rmu

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RESÚMEN La nefrolitotomía percutánea (NLPC) es el tratamiento de elección para litos coraliformes y cálculos renales grandes (mayores de 2 cm). El acceso renal percutáneo se puede lograr ya sea guiado por ultrasonido o fluoroscopia. El método de elección depende de la formación y las preferencias personales. El ultrasonido tiene varias fortalezas como herramienta de intervención y ofrece varias ventajas sobre la fluoroscopía: es fácilmente disponible, portátil, relativamente barato así como la reducción de la exposición a la radiación. Si bien existe una curva de aprendizaje para dominar estas técnicas, su adopción puede conducir a una menor exposición a la radiación para los pacientes, urólogos y proveedores de servicios de salud auxiliares al realizar la nefrolitotomia percutánea. Objetivos Describir la técnica quirúrgica, así como las características clínicas de los pacientes sometidos Nefrolitotomía Percutánea con acceso renal guiado por USG en el Hospital Regional De Alta Especialidad de la Península de Yucatán en el periodo enero 2019 a enero del 2021. Material y método Se realizó un estudio observacional, retrospectivo, descriptivo, de los expedientes clínicos de un total de 22 pacientes con diagnóstico litiasis renal corroborado por estudio de tomografía, sometidos a NLPC con punción guiada por ultrasonido. Resultados Se realizaron un total de 22 NLPC con acceso renal guiado por ultrasonido en un periodo de un año (enero 2019 a enero 2020). El 72.7% de los pacientes fueron del sexo femenino y 27.3% del sexo masculino. El 50% (11) tenían obesidad. El 68.2% (15) pertenecían a la clasificación de riesgo anestésico ASA 2, el 22.7% (5) ASA 3 y 9.1% (2) ASA 1. Dentro de las características del lito de acuerdo a la clasificación de GUY Stone Score, el 40.9% (9) contaban con un GUY III y el 27.3% (6) contaban con un GUY IV. Dentro de las características quirúrgicas: el tracto fue realizado en el 45.5% por un fellow de endourología en el (10) 22.7%, (5) por R5, 9.1% (2) por R4 y 22.7% por médico adscrito de endourología. En cuanto al número de punciones, el 45.5% (10) solamente requirieron una punción. 5 pacientes 2 punciones, 5 pacientes 3 punciones, 1 paciente 4 punciones y 1 paciente más 5 punciones; En el 95.5% (21) el tracto fue exitoso, únicamente en un paciente el tracto fue fallido. La punción se realizó en posición de Valdivia/Galdakao en el 90.0% (20) y en posición prono en el 9.1% (2). El número de tractos realizados fue unitracto en el 95.5% (21). Conclusiones El acceso guiado por ultrasonido para la nefrolitotomía percutánea (NLPC) es una técnica segura, efectiva, libre de radiación y de bajo costo que puede ser utilizada en cualquier hospital. Esta técnica requiere de entrenamiento estructurado el cual debe comenzar desde la residencia.

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Section: Resultsunclassified

Section: Introductionunclassified

Acceso renal guiado por ultrasonido para nefrolitotomía percutánea en un centro de referencia del Sureste de México

Magaña-González

Monzon-Falconi

Cruz-Nuricumbo

2021

rmu

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“…11 Due to the anatomical structure of the renal calices in the body, the posterior calices are preferred to accomplish renal access in safety. 6,24,25 In other words, the PSL not only provides a renal puncture area as large as the TP but also provides the possibility to perform endoscopic combined intrarenal surgery (PCNL and ureteroscopic procedures in the same session). 13 Therefore, stones that have migrated to the ureter during the operation can be easily fragmented using ureteroscopic lithotripsy in the same session.…”

Section: Discussionmentioning

confidence: 99%

“…5 In the past, PCNL was generally applied with the traditional approach, which is to first generate artificial hydronephrosis with retrograde renal pelvis catheterization in the lithotomy position and then to shift into the prone position. 6,7 However, the change of position in this method influences the effectiveness and the safety of surgery. In case of a cardiac or respiratory emergency, management with the patient in the prone position is difficult for anesthesiologists.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Prone Split-Leg Position with the Traditional Prone Position in Percutaneous Nephrolithotomy: A Propensity Score-Matching Study

Yue

Lei

Karagöz

et al. 2021

Journal of Endourology

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Background and Objective: Several positions have been described for percutaneous nephrolithotomy (PCNL). The aim of this study was to compare the safety and effectiveness of the traditional prone position PCNL (TP-PCNL) and the prone split-leg position PCNL (PSL-PCNL). Patients and Methods: A retrospective review was made of the data of 212 patients who underwent prone PCNL in PSL or TP between January 2017 and November 2019. The demographic and preoperative clinical data were used for propensity score-matching (PSM). Following the PSM based on a multivariable logistic regression model, the PSL-PCNL and TP-PCNL groups were compared in preoperative, perioperative, and postoperative parameters. All surgical procedures were performed by an experienced endourologist. Results: After PSM, 51 patients from the PSL-PCNL group were matched to 51 TP-PCNL patients. The stone burden was not statistically significant between the two groups ( p = 0.388). The mean operation time of the two groups was significantly different (81.5 -32.4 minutes vs 93.1 -25.9 minutes, respectively, p = 0.026). The hemoglobin decrease in the PSL-PCNL group was greater than that in the TP-PCNL group (-17.7 -16.9 g/L vs 13.1 -10.9 g/L, p < 0.001). Both groups had similar stone-free rates after 2 weeks ( p = 0.49). No significant difference was observed between the groups in the total complication rate ( p = 1). Conclusions: The application of PSL in PCNL simplifies the surgical procedure and shortens the operating time. Another important advantage is that it allows retrograde intrarenal surgery and ureteroscopy to be performed simultaneously. We recommend the PSL to be applied in PCNL for renal stone patients.

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“…We believe that attention should be paid to four key points during the operation, to avoid complications. (I) Accurate puncture: a good working channel is very helpful to remove the most stones and have the fewest complications (19,20). (II) The channel should be gently expanded, and the direction and depth of channel should be correct rather than deep.…”

Section: Skilled and Gentle Operation To Avoid Complicationsmentioning

confidence: 99%

Case selection and implementation of tubeless percutaneous nephrolithotomy

Mao¹,

Huang²,

Li³

et al. 2021

Transl Androl Urol

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Background: The tubeless percutaneous nephrolithotomy (PCNL) was proposed to eliminate the side effects of the nephrostomy tube in recent years, such as pain, channel infection, postoperative bleeding, and longer hospital stay. But there is neither clinical guidelines nor consensus about tubeless PCNL in clinical practice. The study is aimed to how to implement the tubeless PCNL step by step, including case selection preoperatively, improving the technique of the surgeon, making the correct decisions at the end of the procedure, which had not been previously examined.Methods: From January 2017 to March 2018, 364 consecutive patients requiring PCNL were comprehensively analyzed preoperatively and patients were selected for scheduled tubeless PCNL based on four aspects. The selected patients were divided into two groups according to whether the nephrostomy tube was finally placed. The mean operative time, intraoperative blood loss, stone clearance rate, visual pain score, postoperative hospitalization days and perioperative complications were all evaluated.Results: Based on the preoperative evaluation, 42 patients were selected for tubeless PCNL, among which there were finally 37 cases of completed tubeless PCNL. Compared with patients undergoing conventional PCNL, there were not statistical differences in the mean operative time (P=0.207) or intraoperative blood loss (P=0.450) in the tubeless group. Stone clearance rate was 100% in both groups. The visual pain scores in the tubeless PCNL group were lower on operation day (P=0.029), first postoperative day (P<0.001) and the day of discharge (P=0.025). The postoperative hospitalization for the tubeless PCNL group was shorter than that of the control group (P<0.001). No significant difference in grade 1 complications was seen (P=0.424), and no grade 2 or higher complications were observed in either group. Conclusions:Postoperative pain was significantly relieved and postoperative hospitalization was significantly shortened in the tubeless PCNL group. Tubeless PCNL is safe if patients are carefully selected using four criteria before operation, attention is paid to four key points and five confirmations are made during operation.

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Prone percutaneous nephrolithotomy: its advantages and our technique for puncture

Cited by 13 publications

References 60 publications

Acceso renal guiado por ultrasonido para nefrolitotomía percutánea en un centro de referencia del Sureste de México

Acceso renal guiado por ultrasonido para nefrolitotomía percutánea en un centro de referencia del Sureste de México

Comparison of the Prone Split-Leg Position with the Traditional Prone Position in Percutaneous Nephrolithotomy: A Propensity Score-Matching Study

Case selection and implementation of tubeless percutaneous nephrolithotomy

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