The Barts ‘Flank-Free’ Modified Supine Position for Percutaneous Nephrolithotomy

Bach, Christian; Goyal, Anuj; Kumar, Prashant; Kachrilas, Stefanos; Papatsoris, Athanasios; Buchholz, Noor; Masood, Junaid

doi:10.1159/000341430

Cited by 42 publications

(22 citation statements)

References 19 publications

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“…Lower airway pressure and intrapelvic pressure observed with the oblique-supine position suggest possible advantages in safety. The results of the present study are similar to those of previous studies of oblique-supine PCNL [3,[17][18][19][20][21].…”

Section: Discussionsupporting

confidence: 91%

“…The oblique-supine position for PCNL has advantages over the prone position [3,[17][18][19][20][21], but the current position fixation methods are inadequate [17,22,23]. Therefore, the aim of the present study was to analyze the PNCL outcomes using a patented self-made frame for obliquesupine position.…”

Section: Discussionmentioning

confidence: 99%

“…In this regards, many authors have tried to modify the surgical position for PCNL. In 1998, Valdivia Uria et al [16] proposed the oblique-supine position, which effectively overcame the disadvantages of the prone position, that is, decreased the rate of intraoperative colonic injury, no chest compression, higher degree of comfort, and avoiding troubles of the intraoperative position switch [3,[17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

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Application of a Self-Made Equipment for Patient Positioning during Percutaneous Nephroscopy in the Oblique-Supine Position

Xia

Zhao

et al. 2019

Urol Int

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Background: The oblique-supine position for percutaneous nephrolithotomy (PCNL) has advantages, but the position fixation methods are inadequate. This study aimed to analyze the PCNL outcomes using a patented self-made frame for oblique-supine position. Methods: This was a prospective study of patients scheduled to undergo PCNL at 2 hospitals in China between November 2009 and December 2016. The patients underwent PCNL in the oblique-supine position using the self-made position frame (n = 94). Operative time, stone clearance rate, intraoperative average systolic pressure, intraoperative average heart rate, intraoperative average airway pressure, intraoperative average intrapelvic pressure, and complications were observed. Results: The patients were 45.3 ± 19.7 years old and 71% were male. Stones were of the size 2.5 ± 1.1 cm. The operative time was 95.6 min and the stone clearance rate was 81.9%. Intraoperative systolic blood pressure was 15.13 ± 1.68 kPa. Intraoperative airway pressure was 15.5 ± 2.3 cm H₂O. Postoperative fever was observed in 3.2% of the patients. None had organ injury. Postoperative stay was 4.8 ± 0.6 days. The nephrostomy tube was routinely removed on the 5th day after surgery and the patients were discharged on the following day. Conclusion: The self-made surgical position frame met the position requirements for the oblique-supine PCNL operation. This surgical position frame deserves clinical application and promotion.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Application of a Self-Made Equipment for Patient Positioning during Percutaneous Nephroscopy in the Oblique-Supine Position

Xia

Zhao

et al. 2019

Urol Int

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“…To overcome these drawbacks, PCNL in the supine position has also been described [5]. Moreover, the supine position has been developed to be a more familiar approach for simultaneous combined PCNL and retrograde ureterorenoscopy (URS) for management of complex stone disease [6,7,8,9]. Additionally, some groups have developed the minimally invasive percutaneous nephrolithotomy (MPCNL) technique, i.e.…”

Section: Introductionmentioning

confidence: 99%

Supine Lithotomy versus Prone Position in Minimally Invasive Percutaneous Nephrolithotomy for Upper Urinary Tract Calculi

Zhan

Zhou

et al. 2013

Urol Int

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Objective: To compare operative time, safety and effectiveness of minimally invasive percutaneous nephrolithotomy (MPCNL) in the supine lithotomy versus prone position. Methods: Between January 2008 and December 2010, a total of 109 consecutive patients with upper urinary tract calculi were enrolled and randomly divided into group A (53 patients, supine lithotomy position) and group B (56 patients, prone position). The MPCNL procedures were performed under the guidance of real-time grayscale ultrasound system. The preoperative characteristics, intraoperative and postoperative parameters were analyzed and compared. Results: All patients were successfully operated. There was no signiﬁcant difference between the two groups in stone-free rate (group A 90.1 vs. group B 87.5%, p = 0.45), mean blood loss, number of access tracts, calyx puncture, mean hospital stay (group A 6 ± 1.1 vs. group B 6 ± 1.5 days, p = 0.38) and complications. But the operative time was significantly shortened in supine lithotomy position (group A 56 ± 15 vs. group B 86 ± 23 min, p < 0.001). Conclusions: The effectiveness and safety of the supine lithotomy position for MPCNL were similar to the prone position. However, the supine lithotomy position has an important advantage of reducing the operative time. The supine lithotomy position could be a good choice to perform MPCNL.

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“…[12][13][14][15][16][17][18][19][20] Although there are no formal guidelines in the management of encrusted double-J stents, 15 several authors have reported their series and proposed algorithms: some with multiple sequential surgical techniques; 15,[19][20][21][22][23] others with a one-step approach. 18,24 Even in this single approach technique, after cystolithopaxy or URS in lithotomy position, the patient must be turned prone for PCNL.…”

Section: Introductionmentioning

confidence: 99%

Prone split-leg position to manage encrusted ureteral stents in a single-stage procedure in women: Step-by-step surgical technique

Marchini

Torricelli

Mazzucchi

et al. 2015

CUAJ

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The management of encrusted ureteral stents is costly, time consuming and may be risky for the patient and challenging for the urologist. Treatment modalities for encrusted stents include extracorporeal shock wave lithotripsy, cystolithopaxy, rigid or flexible ureteroscopy with intracorporeal lithotripsy, percutaneous nephrolithotomy, open surgery, and a combination of those methods. In this study we describe the management of severe forgotten encrusted ureteral stents in 3 female patients using a prone splitleg position. This position allows us to effectively treat any site and degree of stent encrustation in a single-session approach with the patient in the same position during the whole procedure. All patients were rendered stent and stone free. No complications occurred. IntroductionIndwelling ureteral stents were introduced in 1967 and were instrumental in the advance of endourology.1 Ureteral stents are mainly used to manage ureteral obstruction due to intrinsic or extrinsic causes (e.g., urolithiasis, strictures, and malignancy) or after any ureteral surgery.1-4 Modern ureteral stents are usually designed in a double-pigtail configuration and are composed of polyurethane and/or polyethylene.5 New biomaterials and ureteral stent coatings, such as heparin and diamond-like carbon compounds, may reduce infection and encrustation rates.6-8 Nevertheless, underlying stone-forming conditions, pregnancy, and total indwelling-stent time affect the level of encrustation. Stent encrustation rates may increase from 9.2% at <6 weeks to 76.3% at >12 weeks. 9The management of encrusted ureteral stents is costly, time consuming and may be risky for the patient and challenging for the urologist. 10 The degree and site of encrustation are important considerations when dealing with forgotten stents. The term ''forgotten, encrusted, calcified (FECal)'' double-J ureteral stent was created to describe stents which cannot be removed cystoscopically without the aid of other auxiliary measures due to encrustation and/or stone formation. 11 The two most severe types of stent encrustation are Grade IV (circular encrustations completely encasing both of the pigtail portions of the stent) and Grade V (diffuse and bulky encrustations completely encasing both of the pigtail and ureteral portions of stent).11 The ideal method for stent encrustation image evaluation is the non-contrast computed tomography (NCCT), as the standard kidney-ureter-bladder x-ray may miss minor encrustations which can also intricate their removal.Treatment modalities for encrusted stents include extracorporeal shock wave lithotripsy (SWL), cystolithotopaxy, retrograde rigid or flexible ureteroscopy with intracorporeal lithotripsy (URS), percutaneous nephrolithotomy (PCNL), open surgery, and a combination of those methods. [12][13][14][15][16][17][18][19][20] Although there are no formal guidelines in the management of encrusted double-J stents, 15 several authors have reported their series and proposed algorithms: some with multiple sequential surgical t...

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The Barts ‘Flank-Free’ Modified Supine Position for Percutaneous Nephrolithotomy

Cited by 42 publications

References 19 publications

Application of a Self-Made Equipment for Patient Positioning during Percutaneous Nephroscopy in the Oblique-Supine Position

Application of a Self-Made Equipment for Patient Positioning during Percutaneous Nephroscopy in the Oblique-Supine Position

Supine Lithotomy versus Prone Position in Minimally Invasive Percutaneous Nephrolithotomy for Upper Urinary Tract Calculi

Prone split-leg position to manage encrusted ureteral stents in a single-stage procedure in women: Step-by-step surgical technique

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