Safety and outcomes of percutaneous nephrolithotomy in the supine position: a single-centre experience
DOI:
https://doi.org/10.18203/2320-6012.ijrms20242283Keywords:
Supine, Staghorn, PCNLAbstract
Background: The technique of percutaneous nephrolithotomy (PCNL) was initially introduced by Fernström and Johansson in 1976, with the patient positioned in the prone position. Valdivia's study showed that PCNL performed in the supine position had comparable results and complications to PCNL performed in other positions, while also offering potential benefits in terms of ergonomics and anesthesia administration
Methods: A prospective interventional study was conducted at Narayana medical college and hospital, a tertiary care centre in Nellore, AP, India between January 2023 to May 2024. Patients with sepsis, blood coagulation abnormalities, bifid pelvicalyceal system, pediatric population were excluded
Results: The median operative duration was 85.59±12.733 min, and the median duration of X-ray exposure was 12 min. The mean (SD) volume of irrigant fluid was 32.9 liter. One puncture in 73 (89.0%) while 9 (11%) needed two punctures. the mean (SD) reduction in hemoglobin level was 0.8±0.13 mg/dl, with no patients requiring a transfusion. 77 patients had no or <3 mm residual fragments, resulting in a stone free rate of 93.9%. of the five patients with residual stones. There were complications in 13 patients (15.85%); 6 (7.31%) had a persistent urine leak for >24 h after nephrostomy removal
Conclusions: Despite the statistically insignificant results, the outcomes were obviously improved and demonstrated to be comparable to other facilities, with a high stone-free rate and low complications, and post-op length of hospital stay. As a result, the efficacy and safety of supine PCNL in our center were confirmed.
References
Fernström I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol. 1976;10(3):257-9.
Valdivia Uría JG, Lachares Santamaría E, Villarroya Rodríguez S, Llop JT, Baquero GA, Lassa JMA. Percutaneous nephrolithectomy: simplified technic (preliminary report). Arch Esp Urol. 1987;40(3):177-80.
Valdivia JG, Valer J, Villarroya S. Why is Percutaneous Nephroscopy Still Performed with the Patient Prone? J Endourol. 1990;8(4):269-77.
Valdivia JG, Valle J, Lopez JA, Rodriguez SV, Navarro CM, Fabian MR, et al. Technique and complications of percutaneous nephroscopy: experience with 557 patients in the supine position. J Urol 1998;160(6pt1):1975-8.
Hoznek A, Rode J, Ouzaid I, Faraj B, Kimuli M, De la Taille A, et al. Modified supine percutaneous nephrolithotomy for large kidney and ureteral stones. Technique and results. Eur Urol. 2012;61(1):164-70.
Wu P, Wang L, Wang K. Supine versus prone position in percutaneous nephrolithotomy for kidney calculi: a meta-analysis. Int Urol Nephrol. 2011;43(1):67-77.
Falahatkar S, Farzan A, Allahkhah A. Is complete supine percutaneous nephrolithotripsy feasible in all patients? Urol Res. 2011;39(2):99-104.
Sofer M, Giusti G, Proietti S, Mintz I, Kabha M, Matzkin H, et al. Upper calyx approachability through a lower calyx access for prone versus supine percutaneous nephrolithotomy. J Urol. 2016;195(2):377-82.
Soliman T, Khalil M, Omar R, Mohey A, Ahmed S, Sherif H, et al. Management of upper calyceal stone by percutaneous nephrolithotomy through lower calyx access: prone versus supine position. Afr J Urol. 2020;26:14.
Choudhury S, Talukdar P, Mandal TK, Majhi TK. Supine versus prone PCNL in lower calyceal stone: Comparative study in a tertiary care center. Urologia. 2021;88(2):148-52.
Safriadi F, Ramdhan D. Comparison of percutaneous nephrolitotomy (PCNL) in prone and supine position: A single centre experience report. Indones J Urol. 2021;28(1):39-43.
Joshi R. Complications and success rate of percutaneous nephrolithotomy in renal stone: A descriptive cross-sectional study. JNMA J Nepal Med Assoc. 2019;57(220):444-8.
Srinivas SU, Gall Z, Lynch N, Pollard A, Counsell A, Brown S, et al. A retrospective, observational study of supine percutaneous nephrolithotomy. J Clin Urol. 2018;11(4):285-92.
Nualyong C, Sathidmangkang S, Woranisarakul V, Taweemonkongsap T, Chotikawanich E. Comparison of the outcomes for retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) in the treatment of renal stones more than 2 centimeters. Insight Urol. 2019;40(1):9-14.
Wang F, Hong Y, Yang Z, Ye L. Comparison of retrograde intrarenal surgery and standard percutaneous nephrolithotomy for management of stones at ureteropelvic junction with high- grade hydronephrosis. Sci Rep. 2021;11(1):14050.
Sohail N, Albodour A, Abdelrahman KM. Percutaneous nephrolithotomy in complete supine flank-free position in comparison to prone position: A single-centre experience. Arab J Urol. 2017;15(1):42-7.
