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Fang H, Zhu F, Cui K, Liu X, Wu S, Hua Y, Lin T, He D, Wei G, Zhang D. An updated systematic review and meta-analysis on the efficacy of supine versus prone position for pediatric PCNL. Int Urol Nephrol 2025:10.1007/s11255-025-04428-y. [PMID: 39971864 DOI: 10.1007/s11255-025-04428-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2025] [Accepted: 02/13/2025] [Indexed: 02/21/2025]
Abstract
BACKGROUND The incidence of pediatric kidney stones is increasing with recurrence rates ranging from 35 to 50%. Supine percutaneous nephrolithotomy (PCNL) presents a viable alternative to the conventional prone position, offering specific benefits but also posing certain risks. OBJECTIVE To update a previously published systematic review and meta-analysis comparing the efficacy of PCNL in the supine versus prone positions in children. METHODS A systematic search of Web of Science, Cochrane Library, PubMed, and Embase was conducted to identify eligible studies. Two authors independently screened the literature and extracted data. The meta-analysis was performed using StataMP 17. The study was prospectively registered in PROSPERO (ID: CRD42024545145). The sensitivity and subgroup analyses explored sources of heterogeneity, and publication bias was assessed with a funnel plot. The study adhered to PRISMA guidelines and the Cochrane Handbook. RESULTS This study included a total of nine studies, comprising five randomized controlled trials and four case-control studies, with 614 patients in total. Compared with the prone position group, the supine position group demonstrated significant advantages in terms of operative time (WMD = - 15.43, 95% CI: - 22.18 to - 8.69, P = 0.0001), hospital stay (WMD = - 0.77, 95% CI: - 1.12 to - 0.42, P = 0.0001), overall complication rate (OR = 0.46, 95% CI: 0.42-0.99, P = 0.046), and hemoglobin decrease (WMD = - 0.22, 95% CI: - 0.40 to - 0.05, P = 0.013). However, no significant differences were observed between the two groups in stone clearance rate, high-grade complication rate, or radiation exposure time. Subgroup analysis revealed that in studies published after 2024, cases of small stones (< 2 cm), and older children (> 9 years), the supine position group had fewer low-grade complications. Additionally, in the supine PCNL group with ultrasound or endoscopy-assisted puncture, radiation exposure time was significantly reduced. CONCLUSION This study shows that supine position PCNL in children is superior to the prone position in terms of operative time, hospital stay, complication rate, and hemoglobin decrease, with no significant difference in stone clearance, high-grade complications, or radiation exposure. The subgroup analysis found that supine position resulted in fewer low-grade complications in studies published after 2024, small stones, and older children. It also significantly reduced radiation exposure with ultrasound or endoscopy-assisted puncture, suggesting that supine position is a safer and more effective option.
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Affiliation(s)
- Honggang Fang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Fuming Zhu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Kongkong Cui
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Xing Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Shengde Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Yi Hua
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Tao Lin
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Dawei He
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Guanghui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Deying Zhang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.
- National Clinical Research Center for Child Health and Disorders, Chongqing, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
- Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China.
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Zoeir A, Mamdoh H, Moussa A, Abdel-Raheem A, Gameel T, Elsherbeny A, Al Debeiky A, Almekaty K, Ragab M, Tawfik A, Puliatti S, Ferretti S, Micali S, Proietti S, Oo MM, Giusti G, Elashry O, Elbahnasy A, Sabaa M, Abo El-Enen M, Bianchi G, Eissa A. Which is easier for beginners: supine or prone position percutaneous nephrolithotomy? Assessment of the learning curve in novice urologists through a randomized clinical trial. Minerva Urol Nephrol 2024; 76:748-758. [PMID: 39831856 DOI: 10.23736/s2724-6051.24.05974-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2025]
Abstract
BACKGROUND Percutaneous nephrolithotomy (PCNL) could be performed in both prone and supine positions. Each position has its own advantages and disadvantages. "Learning curve" is a graph that represents progress of a skill against the time needed to master the technique. We hypothesized that supine PCNL might have a shorter learning curve by novice urologists compared to prone PCNL based on the findings of previous studies assessing the learning curve of both techniques. The aim of this study is to assess the learning curve of prone and supine PCNL among novice urologists to detect which is easier for the beginners. METHODS One hundred and fifty patients undergoing PCNL for renal stones were included and divided into two groups; Group A included 75 patients undergoing supine PCNL and Group B included 75 patients undergoing prone PCNL. Subsequently, each group was subdivided into three subgroups of 25 patients to allow the evaluation of the learning curve of the two novice surgeons as regards: operative time, fluoroscopy time, stone free rate, and complications. RESULTS The mean operative time in group A decreased from of 111.8±13.91 minutes to 84.2±15.86 minutes, and thereafter, decreased to 78.4±12.97 minutes in the three consecutive subgroups. Similarly, in group B, the mean operative time decreased from 122±23.76 minutes to 110.2±17.05 minutes, and thereafter, further decreased to 82±15.34 minutes. The operative time plateau was reached after 25 and 50 cases in groups A and B, respectively. The overall stone free rate, and complications were comparable in both groups. CONCLUSIONS Both supine and prone PCNL are safe and effective; however, supine PCNL may be associated with significantly shorter learning curve.
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Affiliation(s)
- Ahmed Zoeir
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt -
| | - Hussein Mamdoh
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ayman Moussa
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ali Abdel-Raheem
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- Urology Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Tarek Gameel
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed Elsherbeny
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Khaled Almekaty
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Maged Ragab
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed Tawfik
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Stefano Puliatti
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefania Ferretti
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Proietti
- Urology Department, IRCCS San Raffaele Hospital, Ville Turro Division, Milan, Italy
| | - Mon Mon Oo
- Urology Department, IRCCS San Raffaele Hospital, Ville Turro Division, Milan, Italy
| | - Guido Giusti
- Urology Department, IRCCS San Raffaele Hospital, Ville Turro Division, Milan, Italy
| | - Osama Elashry
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Magdy Sabaa
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Giampaolo Bianchi
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Ahmed Eissa
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Porto BC, Santana RN, Duarte IMS, Passerotti CC, Sardenberg RAS, Maia RS, Otoch JP, da Cruz JAS. Flank-free modified supine vs. prone position for pediatric nephrolithotripsy: an updated systematic review and meta-analysis. BMC Urol 2024; 24:262. [PMID: 39614229 PMCID: PMC11607970 DOI: 10.1186/s12894-024-01660-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 11/20/2024] [Indexed: 12/01/2024] Open
Abstract
INTRODUCTION Percutaneous nephrolithotomy (PCNL) is widely performed as the preferred treatment for kidney stones larger than 20 mm in pediatric patients, with current research focusing on comparing outcomes between prone and supine positions to determine optimal procedural positioning. Therefore, the aim of this study is to compare the efficacy of prone versus supine positioning in pediatric PCNL, providing clarity on this critical aspect of the procedure to guide clinical decision-making. METHODS We conducted a systematic review in PubMed, Embase, Scopus, Cochrane, Web of Science and Google Scholar. We included studies that compared PCNL in prone vs supine positions for pediatric patients. Our primary outcome was stone-free rate (SFR). Secondary outcomes included operative time, length of hospital stay and overall complications rate. The statistical analysis was performed using Review Manager 5.4. RESULTS We retrieved 8 articles, with 269 patients in the prone group and 223 patients in the supine group. The mean age of all patients was 7.92 years old. Our findings presented no statistically significant difference in SFR between the two positions (OR 0.67; CI95 0.38, 1.18; p = 0.17; I2 = 0%). Additionally, we noted a significant reduction in operative time in the supine position group (MD 13.75; CI95 4.35, 23.15; p = 0.004; I2 = 84%). At the same time, the length of hospital stay after the procedure was lower in supine group (MD 0.61; CI95 0.34, 0.88; p < 0.0001; I2 = 21%). No difference was observed regarding the total complication rate (OR 1.47; CI95 0.88, 2.47; p = 0.15; I2 = 0%). CONCLUSION Our meta-analysis suggests that PCNL performed in the prone position is equivalent to supine PCNL in terms of SFR. However, mainly in the RCT studies, we could observe benefits of the supine position in comparison of prone position in terms of lower operative time, as well as a reduced postoperative hospital stay.
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Affiliation(s)
- Breno C Porto
- Surgical Technique and Experimental Surgery Department, University of São Paulo School of Medicine, Dr. Arnaldo Ave., 455, São Paulo, SP, 01246903, Brazil
| | - Roberto N Santana
- Ninth of July University, Av. Dom Jaime de Barros Câmara, 90, Sao Bernardo do Campo, SP, 09895-400, Brazil
| | - Ingrid M S Duarte
- Ninth of July University, Av. Dom Jaime de Barros Câmara, 90, Sao Bernardo do Campo, SP, 09895-400, Brazil
| | - Carlo C Passerotti
- Surgical Technique and Experimental Surgery Department, University of São Paulo School of Medicine, Dr. Arnaldo Ave., 455, São Paulo, SP, 01246903, Brazil
| | - Rodrigo A S Sardenberg
- International Teaching and Research Institute - Hapvida NotreDame Intermédica, Paulista Ave, 867, São Paulo, SP, 01418-100, Brazil
- Ninth of July University, Av. Dom Jaime de Barros Câmara, 90, Sao Bernardo do Campo, SP, 09895-400, Brazil
| | - Ronaldo S Maia
- Surgical Technique and Experimental Surgery Department, University of São Paulo School of Medicine, Dr. Arnaldo Ave., 455, São Paulo, SP, 01246903, Brazil
| | - Jose P Otoch
- Surgical Technique and Experimental Surgery Department, University of São Paulo School of Medicine, Dr. Arnaldo Ave., 455, São Paulo, SP, 01246903, Brazil
| | - Jose A S da Cruz
- Surgical Technique and Experimental Surgery Department, University of São Paulo School of Medicine, Dr. Arnaldo Ave., 455, São Paulo, SP, 01246903, Brazil.
- International Teaching and Research Institute - Hapvida NotreDame Intermédica, Paulista Ave, 867, São Paulo, SP, 01418-100, Brazil.
- Ninth of July University, Av. Dom Jaime de Barros Câmara, 90, Sao Bernardo do Campo, SP, 09895-400, Brazil.
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Sezer A, Türedi B, Kucuktopcu O, Hamarat MB, Yilmaz B, Güzel R, Sarica K. Renal Access in Pediatric Supine Miniaturized Percutaneous Nephrolithotomy: Comparative Evaluation of Ultrasound-Fluoroscopy Combined and Biplanar (0°-90°) Fluoroscopic Techniques. J Endourol 2024; 38:1134-1140. [PMID: 39001818 DOI: 10.1089/end.2024.0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2024] Open
Abstract
Introduction: Ultrasound (US)-guided puncture has the benefits of avoiding radiation and limiting the risk of visceral injury. We aimed to evaluate the results of two different renal access techniques during pediatric supine mini percutaneous nephrolithotomy (smPCNL) in a comparative manner. Patients and Methods: Data obtained from pediatric patients undergoing smPCNL by single surgeon between September 2021 and 2023 were reviewed retrospectively. Children were divided into two groups namely; biplanar 0°-90° fluoroscopy (Group-F) and US-fluoroscopy combined (Group-C). In all cases, preoperative, operative, and postoperative findings were recorded. Success was defined as the determination of either no (complete stone-free status) or < 4 mm residual fragments (CIRF) on US and X-ray (postoperative 3rd month) images. Complications were evaluated according to modified Clavien-Dindo classification. Results: Data of 54 patients with a mean age of 8.6 years (Group-F = 30, Group-C = 24) are reviewed. In addition to the similar success rates in both groups (Group-F = 86.7% Group-C = 87.5% p = 0.928), similar minor complications were noted in the majority of the cases. No child required transfusion and/or angioembolization. Although the fluoroscopy and operation time were lower in Group-C, the difference was not statistically significant. Conclusion: US-fluoroscopy combined access technique can be applied with similar success and complication rates in pediatric smPCNL. Ultimately, as experience is gained, this technique may lower radiation exposure, although this was not observed in the current study.
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Affiliation(s)
- Ali Sezer
- Konya City Hospital, Pediatric Urology Clinic, Konya, Turkey
| | - Bilge Türedi
- Konya City Hospital, Pediatric Urology Clinic, Konya, Turkey
| | | | | | - Burak Yilmaz
- Konya City Hospital, Urology Clinic, Konya, Turkey
| | - Rasim Güzel
- Department of Urology, Medistate Hospital, Istanbul, Turkey
| | - Kemal Sarica
- Department of Urology, Health Sciences University, Prof Ilhan Varank Training and Education Hospital, Istanbul, Turkey
- Medical School, Department of Urology, Biruni University, Istanbul, Turkey
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Ananda IGYP, Santosa KB, Yudiana IW, Tirtayasa PMW, Pramana IBP, Prayudi NG, Duarsa GWK. Barts flank-free modified supine position vs prone position in percutaneous nephrolithotomy: Systematic review and meta analysis. Arch Ital Urol Androl 2024; 96:12944. [PMID: 39692421 DOI: 10.4081/aiua.2024.12944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 08/31/2024] [Indexed: 12/19/2024] Open
Abstract
INTRODUCTION Percutaneous Nephrolithotomy (PCNL) has been performed in various positions, including prone position and several modifications of supine position. The Barts flank-free modified supine (FFMS) position is a newly enhanced version of the supine positions. This study aims to compare the outcomes of Barts FFMS and prone position in PCNL. METHODS This study followed PRISMA 2020 guideline and was registered to PROSPERO CRD42024530426. Comprehensive search in PubMed, Sciencedirect, and Scopus was conducted until May 2024. Stone-free rates, complications, surgery duration, fluoroscopy duration, use of nephrostomy, and length of stay were collected. Data were analyzed using RevMan 5.4. RESULTS A total of 4 studies were included in this review. There was no significant difference in stone-free rates between Barts FFMS and prone positions (OR = 1.12, 95% CI 0.64-1.95, p = 0.70). There were no significant difference in incidence of fever (OR = 0.91, 95% CI 0.38-2.18, p = 0.84), need for blood transfusion (OR = 0.46, 95% CI 0.11-1.88, p = 0.28), and urine leakage (OR = 0.41, 95% CI 0.16-1.05, p = 0.06). The surgery duration was significantly shorter in Barts FFMS position than in prone position (MD = -15.48, 95% CI [(-26.42)-(-4.55)], p = 0.006). There was no significant difference in patients requiring nephrostomy (OR = 0.19, 95% CI 0.01-3.75, p = 0.28). There were no significant difference in fluoroscopy duration (MD = 0.27, 95% CI [(-6.85)-7.40], p = 0.94) and the length of hospital stay (MD = -0.20, 95% CI [(-0.74)-0.33], p = 0.46). CONCLUSIONS The surgery duration was significantly shorter in Barts FFMS position than in prone position. There were no significant differences regarding stone-free rates, complications, fluoroscopy duration, use of nephrostomy, and length of hospital stay. This indicates that neither Barts FFMS nor prone position is superior, and the choice should be based on the surgeon's preference and the patient's clinical status.
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Affiliation(s)
| | - Kadek Budi Santosa
- Department of Urology, Faculty of Medicine, Universitas Udayana, Denpasar, Bali; Prof. Dr. I.G.N.G. Ngoerah Hospital, Denpasar, Bali.
| | - I Wayan Yudiana
- Department of Urology, Faculty of Medicine, Universitas Udayana, Denpasar, Bali; Prof. Dr. I.G.N.G. Ngoerah Hospital, Denpasar, Bali.
| | - Pande Made Wisnu Tirtayasa
- Department of Urology, Faculty of Medicine, Universitas Udayana, Denpasar, Bali; Universitas Udayana Teaching Hospital, Badung, Bali.
| | - Ida Bagus Putra Pramana
- Department of Urology, Faculty of Medicine, Universitas Udayana, Denpasar, Bali; Universitas Udayana Teaching Hospital, Badung, Bali.
| | - Nyoman Gede Prayudi
- Department of Urology, Faculty of Medicine, Universitas Udayana, Denpasar, Bali; Prof. Dr. I.G.N.G. Ngoerah Hospital, Denpasar, Bali.
| | - Gede Wirya Kusuma Duarsa
- Department of Urology, Faculty of Medicine, Universitas Udayana, Denpasar, Bali; Prof. Dr. I.G.N.G. Ngoerah Hospital, Denpasar, Bali.
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Maiti K, Khare KD, Pal DK. Supine versus prone percutaneous nephrolithotomy in management of patient with complex renal stone diseases. Urologia 2024; 91:558-562. [PMID: 38497204 DOI: 10.1177/03915603241229801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
OBJECTIVES Compare the surgical outcomes, safety, stone free rate, hospital stay, and complication of prone and supine PCNL in case of complex renal stone. MATERIALS AND METHODS This is an observational study conducted in our institute, it consist of 120 patients over the period of 2 years from July 2021 to June 2023, all the patients were divided into two groups: 60 patients underwent modified supine percutaneous nephrolithotomy (PCNL) and remaining 60 patients underwent standard prone PCNL. The measured data included operative time, number of punctures, blood loss, stone-free rate, length of hospital stays, and rate of complications. RESULTS The two groups were comparable in mean age, male to female ratio, number of punctures, number of tract, size of tract, residual calculi in follow up period, blood transfusion, re-do surgery, chest complication, hospital stay, and postoperative fever and pain. The mean operating time was 1.59 h in supine PCNL and 2.49 h in prone PCNL. The p value was significant (p = 0.001). CONCLUSIONS By this study we observed that the supine PCNL is associated with statistically significant reduced operating time as compared to conventional prone PCNL with advantages of not putting the patient in prone position. The postoperative complications such as pain and fever were not significant when compared in both groups. We conclude our study and found that, the supine PCNL is an equally effective in treating complex renal stone as compared to prone PCNL.
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Affiliation(s)
- Krishnendu Maiti
- Department of Urology, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India
| | - Kani Dayal Khare
- Department of Urology, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India
| | - Dilip Kumar Pal
- Department of Urology, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India
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Ramez M, Desoky EAE, EL-Nahas AR. Supine versus prone pediatric percutaneous nephrolithotomy: A systematic review and meta-analysis. Arab J Urol 2024; 22:253-260. [PMID: 39355790 PMCID: PMC11441026 DOI: 10.1080/20905998.2024.2362462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/27/2024] [Indexed: 10/03/2024] Open
Abstract
Percutaneous nephrolithotomy (PCNL) is the treatment of choice for pediatric nephrolithiasis more than 20 mm. Prone position was the preferred position for decades. Recently, supine position has gained more interest. This meta-analysis aims to evaluate the safety and efficacy of PCNL in supine versus prone position in pediatric population. A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library was performed till 28 February 2024. The study included comparative studies comparing both positions in children that were written in English. A total of three randomized studies and three retrospective studies were included with a total number of 290 patients. Cochrane risk-of-bias tool for randomized trials was used for quality assessment, while Newcastle-Ottawa scale was used for non-randomized controlled trials. The meta-analysis was conducted using Review Manager software. Numerical data were analyzed using standardized mean difference (SMD), while the risk ratio was used for analysis of categorical data. Fixed or random effects models were used according to heterogeneity. There were statistically insignificant differences between both groups for stone-free rate (RR 1.08, 95% CI [0.98-1.18], p = 0.11) and overall complications (RR 0.93, 95% CI [0.59-1.47], p = 0.76). Operation time was significantly shorter in supine group (SMD -0.99, 95% CI [-1.67 to -0.30], p = 0.005). Therefore, comparable efficacy and safety outcomes were proved between both supine and prone positions for PCNL in pediatrics.
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Affiliation(s)
- Mohamed Ramez
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Esam A. E. Desoky
- Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed R. EL-Nahas
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Ravizzini PIC, Lino H, Fleury EDFC, Rangel DA, de Toledo LGM. Comparative analysis of ultrasound-guided percutaneous biopsy of native kidneys in children and adults using the free-flank supine antero-lateral decubitus positioning. Abdom Radiol (NY) 2024; 49:1638-1645. [PMID: 38658444 DOI: 10.1007/s00261-024-04316-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE Ultrasound-guided percutaneous biopsy (USPB) of the native kidneys is the preferred diagnostic method for several nephrological conditions in both adult and pediatric populations. Conventionally, native kidney biopsies are conducted with patients in the prone position (PP). However, an alternative approach involving the supine oblique antero-lateral position (SALP) has been explored, particularly for individuals who are obese, elderly, or critically ill. METHODS This study aimed to assess the feasibility and outcomes of USPB performed in SALP with a Free-Flank setting (FF-SALP) in pediatric patients (Group A) compared to adults (Group B). Data from kidney biopsies conducted between 2008 and 2021 were gathered. The study focused on the safety and the prevalence of biopsy samples containing a minimum of 10 glomeruli, histopathological yield in both groups. RESULTS Complication rates were low in both groups (5.6% vs. 3.7%; p = 0.454), without major complications noted. The pediatric group achieved a significantly higher mean number of glomeruli per biopsy compared to the adult group (20.6 ± 12.3 vs. 15.7 ± 9.4; p < 0.001). However, when evaluating the minimum threshold of 10 glomeruli (76.3% vs. 68.5%; p = 0.072) and histopathologic yield (95.3% vs. 93.5%; p = 0.408), no differences were observed between groups. CONCLUSION USPB of native kidneys in the FF-SALP position is a safe and effective method for tissue sampling in patients with parenchymal disease. It demonstrated comparable diagnostic yields and complication rates in the pediatric and adult populations, providing advantages in terms of airway management, making it particularly useful for pediatric patients that require general anesthesia.
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Affiliation(s)
- Pedro Ivo C Ravizzini
- Department of Radiology, Faculty of Medical Sciences of Santa Casa de Misericordia de São Paulo, R. Jaguaribe, 155 - Vila Buarque, São Paulo, SP, 01224-001, Brazil.
- Department of Urology, Faculty of Medical Sciences of Santa Casa de Misericordia de São Paulo, São Paulo, Brazil.
| | - Henrique Lino
- Department of Radiology, Faculty of Medical Sciences of Santa Casa de Misericordia de São Paulo, R. Jaguaribe, 155 - Vila Buarque, São Paulo, SP, 01224-001, Brazil
| | - Eduardo de Faria Castro Fleury
- Department of Radiology, Faculty of Medical Sciences of Santa Casa de Misericordia de São Paulo, R. Jaguaribe, 155 - Vila Buarque, São Paulo, SP, 01224-001, Brazil
| | - Daniel Azevedo Rangel
- Department of Radiology, Faculty of Medical Sciences of Santa Casa de Misericordia de São Paulo, R. Jaguaribe, 155 - Vila Buarque, São Paulo, SP, 01224-001, Brazil
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9
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Babaoff R, Creiderman G, Darawsha AE, Ehrlich Y, Somani B, Lifshitz DA. Propensity Score-Matched Analysis of Perioperative Outcomes of Supine versus Prone Percutaneous Nephrolithotomy. J Clin Med 2024; 13:2492. [PMID: 38731021 PMCID: PMC11084354 DOI: 10.3390/jcm13092492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/17/2024] [Accepted: 04/21/2024] [Indexed: 05/13/2024] Open
Abstract
Objective: To compare the perioperative outcomes of supine and prone percutaneous nephrolithotomy (PCNL). Methods: A retrospective search of a tertiary medical center database yielded 517 patients who underwent supine (n = 91) or prone (n = 426) PCNL between September 2015 and July 2020. Data on demographics, baseline clinical parameters, and stone burden were included as predictors in a logistic regression model, generating a set of propensity scores. Seventy patients after supine PCNL were propensity score-matched 1:1 with patients after prone PCNL and compared for operative time, perioperative complications, system complexity, and stone-free rate. Results: We found that the operative time was significantly shorter in the supine PCNL group than in the prone PCNL group (85.5 ± 25.2 min vs. 96.4 ± 25.8 min, respectively; p = 0.012). The majority of both groups had low-grade (I-II) complexity systems (85.6% and 88.6%, respectively), with no significant difference among all grade groups (p = 0.749). There were no significant differences between the supine and prone PCNL groups in terms of the overall perioperative complication rate (8.6% vs. 4.3%, respectively; p = 0.301) or stone-free rate (74.3 vs. 65.7%, respectively; p = 0.356), while the rate of blood transfusion was significantly higher in the supine group (p = 0.023). Conclusions: In our study, we used propensity score matching to compare patients who underwent PCNL in the supine or prone position, adjusting for selection bias. Supine PCNL was associated with a shorter operative time but a higher blood transfusion rate, with no differences in the overall complication and stone-free rates.
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Affiliation(s)
- Roi Babaoff
- Department of Urology, Rabin Medical Center, Petah Tikva 4937213, Israel; (G.C.); (D.A.L.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Gherman Creiderman
- Department of Urology, Rabin Medical Center, Petah Tikva 4937213, Israel; (G.C.); (D.A.L.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Abd Elhalim Darawsha
- Department of Urology, Rabin Medical Center, Petah Tikva 4937213, Israel; (G.C.); (D.A.L.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yaron Ehrlich
- Department of Urology, Rabin Medical Center, Petah Tikva 4937213, Israel; (G.C.); (D.A.L.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Bhaskar Somani
- University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK;
| | - David A. Lifshitz
- Department of Urology, Rabin Medical Center, Petah Tikva 4937213, Israel; (G.C.); (D.A.L.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Farkouh A, Park K, Buell MI, Mack N, De Guzman C, Clark T, Baldwin EA, Shete K, Leu R, Amasyali AS, Seibly E, Cheng KW, Song S, Okhunov Z, Baldwin DD. Prone vs supine percutaneous nephrolithotomy: does position affect renal pelvic pressures? Urolithiasis 2024; 52:66. [PMID: 38630256 PMCID: PMC11023995 DOI: 10.1007/s00240-024-01555-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/06/2024] [Indexed: 04/19/2024]
Abstract
The purpose of this study was to measure and compare renal pelvic pressure (RPP) between prone and supine percutaneous nephrolithotomy (PCNL) in a benchtop model. Six identical silicone kidney models were placed into anatomically correct prone or supine torsos constructed from patient CT scans in the corresponding positions. A 30-Fr renal access sheath was placed in either the upper, middle, or lower pole calyx for both prone and supine positions. Two 9-mm BegoStones were placed in the respective calyx and RPPs were measured at baseline, irrigating with a rigid nephroscope, and irrigating with a flexible nephroscope. Five trials were conducted for each access in both prone and supine positions. The average baseline RPP in the prone position was significantly higher than the supine position (9.1 vs 2.7 mmHg; p < 0.001). Similarly, the average RPP in prone was significantly higher than supine when using both the rigid and flexible nephroscopes. When comparing RPPs for upper, middle, and lower pole access sites, there was no significant difference in pressures in either prone or supine positions (p > 0.05 for all). Overall, when combining all pressures at baseline and with irrigation, with all access sites and types of scopes, the mean RPP was significantly higher in the prone position compared to the supine position (14.0 vs 3.2 mmHg; p < 0.001). RPPs were significantly higher in the prone position compared to the supine position in all conditions tested. These differences in RPPs between prone and supine PCNL could in part explain the different clinical outcomes, including postoperative fever and stone-free rates.
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Affiliation(s)
- Ala'a Farkouh
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Kyu Park
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Matthew I Buell
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Nicole Mack
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Cliff De Guzman
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Toby Clark
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Elizabeth A Baldwin
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Kanha Shete
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Rose Leu
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Akin S Amasyali
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Evan Seibly
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Kai Wen Cheng
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Sikai Song
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Zhamshid Okhunov
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - D Duane Baldwin
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA.
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11
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Kumar N, Somani B. Supine tubeless upper pole PCNL under spinal anaesthesia: Safety, feasibility and outcomes from a tertiary endourology centre. Arab J Urol 2024; 22:159-165. [PMID: 38818256 PMCID: PMC11136457 DOI: 10.1080/20905998.2024.2309780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/21/2024] [Indexed: 06/01/2024] Open
Abstract
Objective Supine Percutaneous Nephrolithotomy (PCNL) is being taken up by many urologists in recent times, but there is a tendency to shift to prone PCNL for upper pole puncture. We analyzed the safety, feasibility and outcomes of upper pole access in Supine Percutaneous Nephrolithotomy (sPCNL). Materials and methods A retrospective review of all patients undergoing sPCNL at a tertiary care center was done from January 2021 to December 2022. Data collection was done from the maintained imaging, laboratory and hospital records. All cases with complete data on upper pole access were included. Data analysis was done with Xlstat2021. Results 50 patients with upper pole access were included (64%, 32 with single access and 36%, 18 with multiple accesses). The mean stone size was 23.88 ± 9.99, mean HU was 1093 ± 232.83, and the mean operative duration was 67.92 ± 34.62. Stone clearance rate was 98.82%, with all procedures performed tubeless.The mean haemoglobin drop was 0.75 ± 0.42 gm/dl with 2 (4%) patients needing a blood transfusion. The overall complication rate was 22% with only 1 Clavien Dindo III complication (1 pleural injury and hydrothorax needing USS guided aspiration) and others being Clavien Dindo I/II complications. Conclusion Supine PCNL is a feasible and safe approach for upper pole access. While the procedure can be done tubeless, these procedures must be done in experienced endourology units.
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Affiliation(s)
- Nitesh Kumar
- Consultant Urological Surgeon, Ford Hospital and Research Centre, Patna, India
| | - Bhaskar Somani
- Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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12
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Vrettos T, Martinez BB, Tsaturyan A, Liourdi D, Al-Aown A, Lattarulo M, Liatsikos E, Kallidonis P. Effect of patient positioning on anesthesiologic risk in endourological procedures. Urol Ann 2023; 15:261-265. [PMID: 37664107 PMCID: PMC10471805 DOI: 10.4103/ua.ua_113_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/08/2022] [Indexed: 09/05/2023] Open
Abstract
Objective The objective is to compare supine and prone positions in terms of arterial blood gas during lithotripsy endourology procedures in different stages. Material and Methods Cases of during lithotripsy endourology procedures in our department from March to September 2020 were included prospectively. The variables registered were body mass index, age, the American Society of Anesthesiologists (ASA) score, diabetes mellitus, positive end-expiratory pressure (PEEP), FiO2, stone size, stone location, procedural type, position, procedure duration, PaO2, SaO2, PaCO2, pH, and dynamic compliance. PaO2, SaO2, PaCO2, pH, and dynamic compliance were recorded at the beginning of the procedure, 5 min later, 15 min later, and at the end of the procedure. Results Thirty patients in prone position and 30 in lithotomy position were included in this study. Patients in prone position underwent percutaneous nephrolithotomy, and patients in supine/lithotomy underwent retrograde intrarenal surgery or ureteroscopy. Statistically significant differences were found in PEEP, duration, PaO2 at the beginning, SaO2 at the beginning and at the end of the procedure, PaCO2 at the beginning and at minute 5 and pH at the beginning of the surgery. The saturation PaO2 increased significantly on prone position and was statistically significantly better at the end of the surgery. Conclusions Both prone and supine positions were safe regarding anesthesiologic risk and had no clinically relevant differences in terms of individual comparisons in arterial blood gas parameters in static moments of the procedure. Prone position was related to an increase in PaO2 and a drop in PaCO2 gradually from the beginning to the end of the surgery.
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Affiliation(s)
- Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | | | | | - Despoina Liourdi
- Department of Internal Medicine, General Hospital of Patras Ag. Andreas, Patras, Greece
| | - Abdulrahman Al-Aown
- Department of Urology, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece
- Medical University of Vienna, Austria
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13
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Manav AN, Güzel A. Is supine position safe and effective for the percutaneous nephrolithotomy? Clinical experiences, tip and tricks in learning curve and PSAA technique. Urolithiasis 2023; 51:62. [PMID: 36995494 DOI: 10.1007/s00240-023-01431-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/14/2023] [Indexed: 03/31/2023]
Abstract
AIM The aim of this study was to determine the factors facilitating the supine percutaneous nephrolithotomy technique in learning curve, to compare the supine and prone technique results. MATERIAL AND METHODS 47 patients who required percutaneous nephrolithotomy were included in this study, and they were divided into two groups as supine and prone. Prone technique was performed to 24 patients in the first group. In the second group, the supine technique was performed by calculating the patient-specific access angle for 23 patients. Demographic, preoperative, intraoperative, postoperative parameters, transfusion, and complications of both groups were compared. RESULTS Age, gender, side, stone size, stone-free rate, and length of stay in hospital were not statistically significant between the groups. Operation and fluoroscopy time were lower in the supine group, but it was not statistically significant. The decrease in hemoglobin was higher in the supine group and it was statistically significant (p = 0.027). The decrease in hemoglobin was not symptomatic in both groups. In addition, transfusion rates were similar and not statistically significant. DISCUSSION In previous studies, the supine technique was evaluated in terms of many factors. Process steps were tried to be standardized and improvements were made in the access technique. The supine technique, which uses patient-specific access angle, has similar complication rates as the prone technique. However, the operation and fluoroscopy times are shorter than the prone technique. For surgeons on the learning curve, the supine technique is safe, feasible, and has even shorter operating times with a patient-specific access angle.
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Affiliation(s)
- Alper Nesip Manav
- Department of Urology, Medinova Hospital, Dr. Serkan Kuraz Cd, No:13, 09100, Efeler, Aydın, Turkey.
| | - Ahmet Güzel
- Department of Urology, Aydın State Hospital, Hasanefendi-Ramazan Paşa, Kızılay Cd, No:13, 09100, Efeler, Aydın, Turkey.
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14
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Yu K, Du Z, Xuan H, Cao Y, Zhong H, Li F, Chen Q. The efficacy and safety of one-stage endoscopy combined with intrarenal surgery (mini-nephrostomy tract) in the prone split-leg position for complex renal calculi. Curr Urol 2023; 17:13-17. [PMID: 37692135 PMCID: PMC10487290 DOI: 10.1097/cu9.0000000000000148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background The goal of this study was to determine the safety and efficacy of endoscopic combined intrarenal surgery (ECIRS) performed in the prone split-leg position for the treatment of complex renal stones. Materials and methods A mature ECIRS protocol was designed. Retrospective analysis was conducted of medical records between January 2020 and December 2021 of patients with complex renal stones at one center who underwent ECIRS by 2 skilled surgeons using retrograde flexible ureteroscopy and mini-percutaneous nephrolithotomy in the prone split-leg position. Results A total of 44 patients were included in this study. Mean stone size was 26.1 ± 12.7 mm, and the number of calyces involved was 4.36 ± 2.09. Mean operative time was 71.1 ± 21.8 minutes. Postoperative decline in hemoglobin was 15.8 ± 9.8 g/L. Seventy-five percent of patients achieved stone-free status. The mean number of residual stones was 2.8 ± 2.3, and the mean residual stone size was 10.30 ± 4.76 mm. Six patients (13.6%) developed postoperative complications, including 4 with fever during the first 2 days postoperatively and 2 patients with transient postoperative pain. No patients developed severe complications. Conclusions Endoscopic combined intrarenal surgery in the prone split-leg position can be performed safely by experienced surgeons using retrograde flexible ureteroscopy in conjunction with mini-percutaneous nephrolithotomy as a successful technique for the treatment of complex renal stones.
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Affiliation(s)
| | | | | | | | | | | | - Qi Chen
- Department of Urology, Renji Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
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15
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Tsaturyan A, Vrettos T, Ballesta Martinez B, Liourdi D, Lattarulo M, Liatsikos E, Kallidonis P. Position-related anesthesiologic considerations and surgical outcomes of prone percutaneous nephrolithotomy: a review of the current literature. Minerva Urol Nephrol 2022; 74:695-702. [PMID: 35622348 DOI: 10.23736/s2724-6051.22.04787-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The aim of the current study was to perform a critical review of existing literature and report the potential morbidity of patient positioning during urological surgeries as well as evaluate the surgical outcomes and anesthesiologic benefits and risks of prone percutaneous nephrolithotomy (PCNL). A narrative review of the current literature has been performed. Articles related to position-related injuries and complications under general anesthesia in prone positions were selected, studied, and considered for the current review. We found that under general anesthesia, the prone position improved the oxygenation of patients and increased the elimination of carbon dioxide. A potential risk for position-related anesthesiologic side effects was reported for longer spine surgeries in a prone position. The injuries and position-related side effects were extremely rare following prone PCNL since the mean duration of the procedure was significantly shorter than that of spine surgery. In conclusion, the prone PCNL remains the most often utilized and preferred approach globally with well-established success and complication rates. Clinical outcomes of prone PCNL do not demonstrate an increased rate of anesthesiologic complications compared to the supine approach. Standardization of turnover of the position, and reduction of the operative time warrant a faster and complication-free recovery.
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Affiliation(s)
| | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | | | - Despoina Liourdi
- Department of Urology, University of Patras, Patras, Greece.,Department of Internal Medicine, Ag. Andreas General Hospital of Patras, Patras, Greece
| | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece - .,Department of Urology, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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Zeng G, Zhong W, Mazzon G, Choong S, Pearle M, Agrawal M, Scoffone CM, Fiori C, Gökce MI, Lam W, Petkova K, Sabuncu K, Gadzhiev N, Pietropaolo A, Emiliani E, Sarica K. International Alliance of Urolithiasis (IAU) Guideline on percutaneous nephrolithotomy. Minerva Urol Nephrol 2022; 74:653-668. [PMID: 35099162 DOI: 10.23736/s2724-6051.22.04752-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The International Alliance of Urolithiasis (IAU) would like to release the latest guideline on percutaneous nephrolithotomy (PCNL) and to provide a clinical framework for surgeons performing PCNLs. These recommendations were collected and appraised from a systematic review and assessment of the literature covering all aspects of PCNLs from the PubMed database between January 1, 1976, and July 31, 2021. Each generated recommendation was graded using a modified GRADE methodology. The quality of the evidence was graded using a classification system modified from the Oxford Center for Evidence-Based Medicine Levels of Evidence. Forty-seven recommendations were summarized and graded, which covered the following issues, indications and contraindications, stone complexity evaluation, preoperative imaging, antibiotic strategy, management of antithrombotic therapy, anesthesia, position, puncture, tracts, dilation, lithotripsy, intraoperative evaluation of residual stones, exit strategy, postoperative imaging and stone-free status evaluation, complications. The present guideline on PCNL was the first in the IAU series of urolithiasis management guidelines. The recommendations, tips and tricks across the PCNL procedures would provide adequate guidance for urologists performing PCNLs to ensure safety and efficiency in PCNLs.
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Affiliation(s)
- Guohua Zeng
- Department of Urology, Guangdong Key Laboratory of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wen Zhong
- Department of Urology, Guangdong Key Laboratory of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Simon Choong
- University College Hospital of London, Institute of Urology, London, UK
| | - Margaret Pearle
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Madhu Agrawal
- Department of Urology, Center for Minimally Invasive Endourology, Global Rainbow Healthcare, Agra, India
| | | | - Cristian Fiori
- Department of Urology, San Luigi Hospital, University of Turin, Turin, Italy
| | - Mehmet I Gökce
- Department of Urology, Faculty of Medicine, University of Ankara, Ankara, Turkey
| | - Wayne Lam
- Division of Urology, Queen Mary Hospital, Hong Kong, China
| | - Kremena Petkova
- Military Medical Academy, Department of Urology and Nephrology, Sofia, Bulgaria
| | - Kubilay Sabuncu
- Department of Urology, Karacabey State Hospital, Karacabey-Bursa, Turkey
| | - Nariman Gadzhiev
- Department of Urology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Esteban Emiliani
- Department of Urology, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Kemal Sarica
- Medical School, Department of Urology, Biruni University, Istanbul, Turkey -
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Soytas M. A new safe and ergonomic manipulation tool for the flank free supine position: 'U-Pad'. J Endourol 2022; 36:1007-1012. [PMID: 35481815 DOI: 10.1089/end.2021.0949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION One of the most important problems in the supine percutaneous approach to the kidney is the narrow surgical surface area (SSA) in the lumbar region. Herein, the spatial and angular geometric advantages of the U-shaped lumbar pad (U-Pad) used as a new positioning tool for safety and ergonomics in the supine percutaneous approach have been revealed. MATERIALS AND METHODS Data of patients who underwent endoscopic combined intrarenal surgery (ECIRS) using the U-Pad for kidney stones between March and September 2021 were prospectively collected. The demographic, preoperative, operative, and postoperative data of patients have been saved. The patients were positioned first with the standard gel pad (Group 1) and then with the U-Pad (Group 2). Both SSA (X and X+Y, cm2) and angular degree (α and β,0) calculations were compared. Fluoroscopy images with the same settings (97 kV/3.00 mA) were visually compared. In geometric data, trapezoidal area formula ((upper base+lower base) X height/2) and goniometer were used to compare with Paired t-test. RESULTS Endoscopic combined intrarenal surgery was performed on 17 patients, 13 men and, 4 women, with a median age of 39 (range 32-47). The median body mass index (BMI) was 26.2 (23.5-29.1). Stone localization and features were recorded. The median SSA was calculated as 35.7 cm2 in group 1 and 97.3 cm2 in group 2, and it was calculated that the total SSA increased to 272.5% with a median of 61.6 cm2 extra surgical area. Similarly, the downward manipulation angle was 320 (α0) in group 1, while it was 60.60 (β0) in group 2, and the median extra motion angle was calculated as 28.60 (89.3%). CONCLUSION The U-Pad is a safe and rapid tool in the supine percutaneous approach to the kidney, providing at least 2 times the extra SSA and manipulation angle.
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Affiliation(s)
- Mustafa Soytas
- Istanbul Medipol University, 218502, Department of Urology, Medipol Mega Hastaneler Kompleksi Bağcılar İstanbul, Istanbul, Turkey, 34083;
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18
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Seleem MM, Eliwa A, Abd Elwahab KM, Bendary L, Elderey MS, Desoky E. Flank free modified supine versus prone ultra mini percutaneous nephrolithotomy in treatment of medium sized renal pelvic stone a randomized clinical trial. J Endourol 2022; 36:1149-1154. [PMID: 35316078 DOI: 10.1089/end.2022.0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION & OBJECTIVES percutaneous nephrolithotomy (PNL) is the standard treatment of renal stone more than 2 cm. ultra-mini-percutaneous nephrolithotomy had emerged in the last decade as a new technique in treating renal stones less than 2 cm. in this study we compare between outcomes of (UMP) in modified flank free supine (FFSP), and prone position. MATERIALS & METHODS A prospective randomized study was conducted between January 2016 and April 2020, including 122 patients, divided into two matched groups. Group A included 61 patients who underwent UMP in FFSP, and group B included 61 patients who underwent UMP in a prone position. All patients had a single renal pelvic stone 1-2 cm. Patients with a single kidney, renal anomalies, BMI≥40, history of ipsilateral renal surgery, and age less than 18 years were excluded. In both groups, the dilatation was done up to 13 f; a holmium laser was used through a 9f ureteroscope for fragmentation. Nephrostomy tube and ureteric stent were used only when indicated. RESULTS 122 patients who divided into two groups. The mean age was 40.09±13.63 and 39.67±13.80 years in both groups, respectively. The operative time was 63.64±9.22 and 78.48±9.55 minutes in groups A &B, respectively (P=0.0001). The fluoroscopy time was 3.47±0.56 and 4.45±0.39 minutes in groups A &B, respectively (P=0.0001).no significant difference between both groups regarding operative and post-operative complications. Shift to miniPNL was needed in one patient in group A and four patients in group B due to impaired vision. The hospital stay was 25.36±4.23 and 26.13±4.76 hours in both groups, respectively. The initial stone-free rate was 95.1% and 91.8% in both groups, respectively. CONCLUSIONS ultra-mini-percutaneous nephrolithotomy in modified supine position shows comparable results to the prone position regarding stone-free rate, hospital stay, and perioperative complication, with significantly shorter operative and fluoroscopy time.
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Affiliation(s)
- Mohamed M Seleem
- Zagazig University Faculty of Human Medicine, 68865, urology, Zagazig, Egypt;
| | - A Eliwa
- Zagazig University Faculty of Human Medicine, 68865, urology, Zagazig, Egypt;
| | | | - L Bendary
- Zagazig University Faculty of Human Medicine, 68865, Zagazig, Egypt;
| | - Mohamed S Elderey
- Zagazig University Faculty of Human Medicine, 68865, urology, saad zaghlol st, zagazig, zagazig, sharkia, Egypt, 44519;
| | - Esam Desoky
- Zagazig University Faculty of Human Medicine, 68865, urology, Zagazig, Egypt;
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19
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Arıman A, Merder E, Toprak E. Evaluation and comparison of S.T.O.N.E. and Guy's scoring systems for predicting percutaneous nephrolithotomy outcomes in supine position. Urologia 2022; 89:397-403. [PMID: 34989263 DOI: 10.1177/03915603211037605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Percutaneous nephrolithotomy (PCNL) was applied in the prone position until recently. But also, in recent years supine positions was applied in patients with kidney stones. Predicting how much renal stones can be cleared after surgery and possibility of complications is an important question for both surgeons and patients. Therefore different scoring systems are used to evaluate outcomes of PCNL before surgery. PATIENTS AND METHODS Between 2018 and 2020, 80 patients with renal stone who underwent PCNL in the supine position were evaluated preoperatively by S.T.O.N.E. and Guy's scoring systems (GSS). The predictions of both scoring systems for stone-free and complication rates in patients who underwent PCNL in the supine position were evaluated. Also, these scoring systems were compared among themselves for reliability. RESULT In both scoring systems, there was a statistically significant difference between postoperative stone-free (SF) and residual stone (RS) of patients and in predicting the likelihood of complications in patients. No statistically significant difference was found between the two scoring systems in predicting the stone-free rate. CONCLUSION Our findings revealed that S.T.O.N.E. nephrolithometry and Guy's score systems can be used effectively to predict stone-free rate, complications, and operation duration in supine position PCNL for renal stones.
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Affiliation(s)
- Ahmet Arıman
- Urology Department, Health Science University, Prof Dr Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Erkan Merder
- Urology Department, Health Science University, Prof Dr Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Erdem Toprak
- Urology Department, Health Science University, Prof Dr Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
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20
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Knoll T. Percutaneous Nephrolithotomy: Which Position? The Referee's Verdict. EUR UROL SUPPL 2022; 35:4-5. [PMID: 34825228 PMCID: PMC8605050 DOI: 10.1016/j.euros.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 11/01/2022] Open
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21
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Mohyelden K, Abdel-Rassoul MA, Dogha MM, Kadry A, Mostafa A. One-shot dilatation versus metal dilator during percutaneous nephrolithotomy in Flank-free supine position: A Randomized Controlled Study. J Endourol 2021; 36:727-733. [PMID: 34969263 DOI: 10.1089/end.2021.0378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The creation and dilatation of the nephrostomy tract is a fundamental step in PCNL. In one-shot dilatation (OSD), we used a single Amplatz dilator over a central Alken rod. PCNL in the supine position is as effective and safe as in the prone position. The Barts flank-free modified supine position sum several advantages of the different supine positions. We evaluated the efficacy and safety of OSD compared to metal telescopic dilatation (MTD) during PCNL while the patient was in Barts flank-free modified supine position. MATERIALS AND METHODS Within 2.5 years, 150 patients with kidney stones candidates for PCNL were randomized into two equal groups according to the dilatation technique. In the OSD group, dilatation was performed using a single Amplatz dilator (30 Fr) and in the MTD group dilatation was performed by sequential MTD (9-30 Fr). All PCNL procedures were done with patients in Barts flank-free modified supine position. Patient characteristics, operative data, and results were collected for statistical analysis. RESULTS There are no statistically significant differences between both groups regarding patients' characters. The tracts were successfully dilated in all patients. Statistical analyses show a significant difference (p ˂0.05) between both groups regarding the time of dilatation (sec) (68 ±15 Vs 147 ±18), time of X-ray exposure (sec) (during dilatation; 36 ±10 Vs 61 ±15 and the total; 157 ±16 Vs 181 ±20), hemoglobin loss (mg/dl) (0.7 ±0.2 Vs 1.2 ±0.3) and hospital stay (day) (3 ±0.6 Vs 3.7 ±0.7) with favorable results to OSD. Complication rates were comparable between the two groups. CONCLUSIONS One-shot dilatation is efficient as MTD during PCNL while patients in Barts flank-free modified supine position, with less dilatation time, X-ray exposure, blood loss, and hospital stay than MTD.
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Affiliation(s)
- Khaled Mohyelden
- Fayoum University Faculty of Medicine, 158405, UROLOGY, Fayoum Government, Fayoum, Egypt, 63514.,Egypt;
| | | | | | - Ahmed Kadry
- Suez Canal University, 68831, Urology, Ismailia, Egypt;
| | - Amro Mostafa
- Cairo University Kasr Alainy Faculty of Medicine, 63527, Cairo, Egypt;
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22
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Desoky E, Sakr A, Elsayed ER, Ali MM. Ultra-mini-percutaneous nephrolithotomy in flank-free modified supine position versus prone position in treatment of pediatric renal pelvic and lower calyceal stones. J Endourol 2021; 36:610-614. [PMID: 34861776 DOI: 10.1089/end.2021.0557] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To report the safety and efficacy of ultra-mini-percutaneous nephrolithotomy (UMPCNL) in flank free modified supine (FFMS) and prone positions in management of pediatric renal calculi. PATIENTS & METHODS This prospective randomized study included 55 pediatric patients with symptomatic renal stones and suitable for ultra-mini-percutaneous nephrolithotomy. They were randomized into two groups. Group A included 28 patients who were treated by UMPCNL in FFMS position (with a pad below the ipsilateral shoulder and buttocks, putting ipsilateral upper limb over the chest, and crossing the extended ipsilateral lower limb over the flexed contralateral one) and Group B included 27 patients treated by UMPCNL in the prone position. In both groups dilatation was done to 13 French sheath allowing the introduction of 6/7.5 French semi-rigid ureteroscope and fragmentation of stones by Ho:YAG laser with a 550-μm fiber laser lithotripter. RESULTS The operation time in FFMS position UMPCNL group was significantly shorter than prone position UMPCNL group (84.3±9.87 vs. 99.3±8.75) minutes with p=0.022. There was no significant difference between both groups in terms of stone free rate (89.3% vs. 88.9%), overall complication rate (including transient fever) (21.4% vs. 18.5%), post-operative pain (VAS score) (3.4±0.8 vs. 3.3±0.9), or hospital stay (3.53±0.8 vs. 4.1±1.1) days. CONCLUSION Both ultra-mini-percutaneous nephrolithotomy in FFMs and prone positions are feasible, safe and effective in treatment of pediatric renal stones with relatively shorter operative time in FFMS position.
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Affiliation(s)
- Esam Desoky
- Zagazig University, Urology, 42 Mostafa Foad St.-Manshiet Abaza, Zagazig, Egypt, 44511;
| | - Ahmed Sakr
- Zagazig University, urology, zagazig, Egypt;
| | - Ehab Raafat Elsayed
- Zagazig university hospital, Urology , Egypt -sharkia, Zagazig, Zagazig , Sharkia, Egypt, 44111;
| | - Maged M Ali
- Zagazig University Faculty of Human Medicine, 68865, urology, Al-Sharqia, Zagazig, Bahr street, Zagazig, Egypt, Zagazig, Egypt, 44519, EGYPT;
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23
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Miçooğulları U, Kamacı D, Yıldızhan M, Umut Kılıç F, Çetin T, Çakıcı ÖU, Keske M, Yiğit Yalçın M, Ardıçoğlu A. Prone versus Barts “flank-free” modified supine percutaneous nephrolithotomy: a match-pair analysis. Turk J Med Sci 2021; 51:1373-1379. [PMID: 33550764 PMCID: PMC8283509 DOI: 10.3906/sag-2011-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/06/2021] [Indexed: 11/25/2022] Open
Abstract
Background/aim In this study, we aimed to compare the results of prone and Barts “flank-free” modified supine percutaneous nephrolithotomy (PCNL) operations in our clinic. Materials and methods The data from patients that underwent Barts “flank-free” modified supine PCNL (BS-PCNL) (n = 52) between June 2018 and July 2020 and prone PCNL (P-PCNL) (n = 286) between April 2014 and June 2018 were retrospectively evaluated. Of those 286 patients, 104 patients whose sex, age, body mass index, American Society of Anesthesiology score, stone localization, stone size, and hydronephrosis matched the BS-PCNL group in a 1:2 ratio were included in the study. The groups were compared in terms of intraoperative outcome, complication rates, and stone-free rates. Results The mean age of all patients (58 females, 98 males) included in the study was 41.8 ± 15.2 years, and the mean body mass index (BMI) was 24.7 ± 2.9 kg/m2. The mean operation time was significantly shorter in the BS-PCNL group than in the P-PCNL group (80.2 ± 15.1 min vs. 92.4 ± 22.7 min and p = 0.01). There was no significant difference between the two groups in terms of fluoroscopy time, intraoperative complications, postoperative complications, and stone-free rates. Conclusion Our study shows that BS-PCNL is an effective and safe method that significantly reduces the operation time and should be considered as one of the primary treatment options for patients scheduled for PCNL.
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Affiliation(s)
- Uygar Miçooğulları
- Department of Urology, University of Health Sciences, Tepecik Education and Research Hospital, İzmir, Turkey
| | - Davut Kamacı
- Department of Urology, Ankara City Hospital, Ankara, Turkey
| | | | - Furkan Umut Kılıç
- Department of Urology, Ankara Yildirim Beyazit University, School of Medicine affiliated with Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Taha Çetin
- Department of Urology, University of Health Sciences, Tepecik Education and Research Hospital, İzmir, Turkey
| | - Özer Ural Çakıcı
- Department of Urology, Ankara Medical Park Hospital, Ankara, Turkey
| | - Murat Keske
- Department of Urology, Kayseri City Hospital, Kayseri, Turkey
| | - Mehmet Yiğit Yalçın
- Department of Urology, University of Health Sciences, Tepecik Education and Research Hospital, İzmir, Turkey
| | - Arslan Ardıçoğlu
- Department of Urology, Ankara Yildirim Beyazit University, School of Medicine affiliated with Ministry of Health Ankara City Hospital, Ankara, Turkey
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24
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Gupta S, Kasim A, Pal DK. Supine tubeless PCNL in horseshoe kidney (a series of cases). Urologia 2021; 89:559-563. [PMID: 34006150 DOI: 10.1177/03915603211015546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Objective of this case series is accurate access to the respective calyx with stone in horseshoe kidney while performing percutaneous nephrolithotmy in supine position. Reducing operative time and anaesthetic morbidity while performing percutaneous nephrolithotomy in horseshoe kidney with nephrolithiasis in supine position. MATERIALS AND METHODS Four patient with one having bilateral renal calculi with horshoe kidney were selected randomly. There were no preference for age, gender; size, location and laterality of stone or BMI. All the patients fit into the AUA guideline criteria for management by percutaneous nephrolithotomy. Preoperative, perioperative and follow up data were collected. RESULTS Four patients with one having bilateral renal calculi underwent supine tubeless PCNL in 1 year in GMSV position. There was no intraoperative, post operative or on follow up complications in any patient. In all the patients stones were cleared completely in single setting. CONCLUSION Supine percutaneous nephrolithotomy in horseshoe kidney is an alternative to the standard prone percutaneous nephrolithotomy in the horseshoe kidney. It provides an additional benefit of performing the procedure in a single position, which is known to reduce total operating time, less anaesthesia related complications and less neuromusculoskeletal injury.
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Affiliation(s)
- Sandeep Gupta
- Department of Urology, Institute of Post Graduate Medical Education and Research & SSKM Hospital, WB, India
| | - Atar Kasim
- Department of Urology, Institute of Post Graduate Medical Education and Research & SSKM Hospital, WB, India
| | - Dilip Kumar Pal
- Department of Urology, Institute of Post Graduate Medical Education and Research & SSKM Hospital, WB, India
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25
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Lim EJ, Osther PJ, Valdivia Uría JG, Ibarluzea JG, Cracco CM, Scoffone CM, Gauhar V. Personalized stone approach: can endoscopic combined intrarenal surgery pave the way to tailored management of urolithiasis? Minerva Urol Nephrol 2021; 73:428-430. [PMID: 33949186 DOI: 10.23736/s2724-6051.21.04443-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ee J Lim
- Department of Urology, Singapore General Hospital, Singapore -
| | - Palle J Osther
- Department of Urology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken, Denmark
| | - José G Valdivia Uría
- Department of Urology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | | | | | - Vineet Gauhar
- Department of Urology, Ng Teng Fong Hospital, Singapore
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26
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Lopes RI, Perrella R, Watanabe CH, Beltrame F, Danilovic A, Murta CB, Claro JFDA, Vicentini FC. Patients with encrusted ureteral stents can be treated by a single session combined endourological approach. Int Braz J Urol 2021; 47:574-583. [PMID: 33621006 PMCID: PMC7993973 DOI: 10.1590/s1677-5538.ibju.2020.0511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/22/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To describe our experience in the management of retained encrusted ureteral stents using a single session combined endourological approach. MATERIALS AND METHODS Patients with retained encrusted ureteral stents who had been submitted to a single session combined endourological approach from June 2010 to June 2018 were prospectively evaluated. Patients were divided according to the Forgotten-Encrusted-Calcified (FECal) classification. The stone burden, surgical intervention, number of interventions until stone free status, operation time, hospital stay, complications, stone analysis, and stone-free rate were compared between groups. ANOVA was used to compare numerical variables, and the Mann-Whitney or Chi-square test to compare categorical variables between groups. RESULTS We evaluated 50 patients with a mean follow-up of 2.9±1.4 years (mean±SD). The groups were comparable in terms of age, sex, laterality, BMI, comorbidities, ASA, reason for stent passage, and indwelling time. The stone burden was higher for grades IV and V (p=0.027). Percutaneous nephrolithotomy was the most common procedure (p=0.004) for grades IV and V. The number of procedures until the patients were stone-free was 1.92±1.40, and the hospital stay (4.2±2.5 days), complications (22%), and stone analysis (66% calcium oxalate) were similar between groups. The stone-free rate was lower in grades III to V (60%, 54.5%, and 50%). CONCLUSIONS The endoscopic combined approach in the supine position is a safe and feasible technique that allows removal of retained and encrusted stents in a single procedure. The FECal classification seems to be useful for surgical planning.
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Affiliation(s)
- Roberto Iglesias Lopes
- Divisão de Urologia, Hospital Brigadeiro, São Paulo, SP, Brasil.,Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | | | | | | | - Alexandre Danilovic
- Divisão de Urologia, Hospital Brigadeiro, São Paulo, SP, Brasil.,Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | | | | | - Fabio Carvalho Vicentini
- Divisão de Urologia, Hospital Brigadeiro, São Paulo, SP, Brasil.,Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
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27
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Zampini AM, Bamberger JN, Gupta KR, Gallante B, Atallah W, Gupta M. FACTORS AFFECTING PATIENT RADIATION EXPOSURE DURING PRONE AND SUPINE PERCUTANEOUS NEPHROLITHOTOMY. J Endourol 2021; 35:1448-1453. [PMID: 33847176 DOI: 10.1089/end.2020.0870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Purpose Radiation exposure from fluoroscopy poses risks to patients and surgeons. Percutaneous Nephrolithotomy (PCNL) has traditionally required fluoroscopy, however the use of ultrasound (US) has decreased radiation exposure. US-guidance in supine PCNL may further reduce radiation exposure. In this study we investigate patient and operative factors affecting fluoroscopy time (s), total radiation dose (mGy) and effective radiation dose (ERD) (mSv) in patients undergoing US-guided supine or prone PCNL. Methods: We performed a retrospective study of patients undergoing US-guided PCNL in prone position and supine position. Patients with multiple access tracts, pre-existing renal access or fluoroscopic renal access were excluded. Patient demographic, radiologic and operative data were collected, and compared between the two groups. Results: 99 patients were included: 45 prone (P-PCNL) and 54 supine (S-PCNL). There were no significant demographic differences between the two groups. Operative time, access location, tract length and total radiation dose (mGy) also did not differ. S-PCNL was associated with lower ERD (2.92mSv ± 0.32 vs 5.3mSv ± 0.7, p=0.0014) despite increased fluoroscopy time (86.32s ± 7.7 vs. 51.00s ± 5.1, p=0.004), and was more likely a mini-PCNL (35.2‰ vs 15.9‰, p=0.032). In multivariate analysis, supine PCNL remained associated with reduced ERD compared to prone (p=0.002), whereas BMI (p<0.001) and staghorn calculi (p<0.001) were independently associated with increased ERD.
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Affiliation(s)
- Anna M Zampini
- Icahn School of Medicine at Mount Sinai, 5925, Department of Urology, New York, New York, United States.,Cleveland Clinic, 2569, Glickman Urological and Kidney Institute, Cleveland, Ohio, United States;
| | - Jacob N Bamberger
- Icahn School of Medicine at Mount Sinai, 5925, Department of Urology, 425 W 59th St, Suite 4F, New York, New York, United States, 10029-6574;
| | - Kasmira R Gupta
- Northwestern University, 3270, No, Evanston, Illinois, United States;
| | - Blair Gallante
- Icahn School of Medicine at Mount Sinai, 5925, Department of Urology, 425 W. 59th Street, Suite 9F, New York, New York, United States, 10019;
| | - William Atallah
- Icahn School of Medicine at Mount Sinai, 5925, Department of Urology, New York, New York, United States;
| | - Mantu Gupta
- Icahn School of Medicine at Mount Sinai, 5925, Department of Urology, New York, New York, United States;
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Kamal WK, Alhazmy A, Alharthi M, Al Solumany A. Trends of percutaneous nephrolithotomy in Saudi Arabia. Urol Ann 2021; 12:352-359. [PMID: 33776332 PMCID: PMC7992526 DOI: 10.4103/ua.ua_100_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 11/07/2019] [Indexed: 11/16/2022] Open
Abstract
Objective: The objective of the study was to present the current practice patterns on percutaneous nephrolithotomy (PCNL) in Saudi Arabia and to compare it with the international patterns and to observe the adherence to the guidelines. Materials and Methods: A survey consisting of 28 questions was sent to urologists working in Saudi Arabia using a Google Forms questionnaire. The questioner covered most aspects of performing PCNL starting from preparing the patient till discharging him. Results: One hundred and thirty-two replied to the survey. Almost 70.2% performed PCNL and 59.1% of them learned PCNL during residency. The access was obtained by the urologists in 80.3% from the participants, 68.2% of them uses fluoroscopic guidance for the puncture. The majority (80.3%) perform PCNL in the prone position. Nearly 69.7% use the balloon dilators and 16.7% use the Amplatz dilators. For kidney drainage, 60.6% place a nephrostomy tube and a double-J stent (DJ stent) together and 4.5% perform tubeless PCNL (DJ stent only). About 45.5% stated that the introduction of flexible ureteroscopy decreased the rate of doing PCNL for >20%. Conclusions: Data obtained from a group of urologists in Saudi Arabia showed that the majority of urologists practicing in Saudi Arabia perform PCNL. They usually learn PCNL during residency. We observe that the majority of urologists attach to the original patterns in PCNL, i.e., they predominantly prefer the prone position and use fluoroscopy to gain the PCNL access. Furthermore, the data showed that new trends in PCNL did not gain a lot of momentum as few practices miniaturized PCNL and tubeless PCNL. The majority use balloon dilators and combined ultrasonic/pneumatic lithotripters. The complication rate encountered by the participants is concomitance with the published international figures. The introduction of flexible ureteroscopy highly decreased the rate of doing PCNL for most urologists.
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Affiliation(s)
| | - Ali Alhazmy
- Department of Urology, King Fahd Hospital, Jeddah, Saudi Arabia
| | - Majed Alharthi
- Department of Urology, King Fahd Hospital, Jeddah, Saudi Arabia
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Choong S, DE LA Rosette J, Denstedt J, Zeng G, Sarica K, Mazzon G, Saltirov I, Pal SK, Agrawal M, Desai J, Petrik A, Buchholz N, Maroclo MV, Gordon S, Sridhar A. Classification and standardized reporting of percutaneous nephrolithotomy (PCNL): International Alliance of Urolithiasis (IAU) Consensus Statements. Minerva Urol Nephrol 2021; 74:110-118. [PMID: 33439573 DOI: 10.23736/s2724-6051.20.04107-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study was to reach a consensus in the classification and standardized reporting for the different types of PCNLs. METHODS The RAND/UCLA appropriateness methodology was used to reach a consensus. Thirty-two statements were formulated reviewing the literature on guidelines and consensus on PCNLs, and included procedure specific details, outcome measurements and a classification for PCNLs. Experts were invited to two rounds of input, the first enabled independent modifications of the proposed statements and provided the option to add statements. The second round facilitated scoring of all statements. Each statement was discussed in the third round to decide which statements to include. Any suggestion or disagreement was debated and discussed to reach a consensual agreement. RESULTS Twenty-five recommendations were identified to provide standardized reporting of procedure and outcomes. Consensual scoring above 80% were strongly agreed upon by the panel. The top treatment related outcomes were size of sheath used (99.1%) and position for PCNL (93.5%). The highest ranked Outcome Measures included definition of postoperative hospital length of stay (94.4%) and estimated blood loss (93.5%). CONCLUSIONS The consensus statements will be useful to clarify operative technique, in the design of clinical trials and standardized reporting, and presentation of results to compare outcomes of different types of PCNLs.
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Affiliation(s)
- Simon Choong
- Institute of Urology, University College London Hospitals, London, UK
| | | | - John Denstedt
- Division of Urology, University of Western Ontario, London, ON, Canada
| | - Guohua Zeng
- Department of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kemal Sarica
- School of Medicine, Department of Urology, Biruni University, Istanbul, Turkey
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy -
| | - Iliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Shashi K Pal
- Department of Urology, Apollo Group of Hospitals and Holy Family Hospital, New Delhi, India
| | - Madhu Agrawal
- Department of Urology, Center for Minimally-Invasive Endourology, Global Rainbow Healthcare, Agra, India
| | - Janak Desai
- Department of Urology, Samved Hospital, Ahmedabad, India
| | - Aleš Petrik
- Department of Urology, Region Hospital Ceske Budejovice, Prague, Czech Republic
| | - Noor Buchholz
- Department of Urology, Sobeh's Vascular and Medical Center, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Marcus V Maroclo
- Unit of Endourology, Hospital de Base of the Federal District, Brasília, Brazil
| | - Stephen Gordon
- Department of Urology, Epsom and St. Helier University Hospitals NHS Trust, Surrey, UK
| | - Ashwin Sridhar
- Institute of Urology, University College London Hospitals, London, UK
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Abdrabuh AM. Impact of weight on stone-free rate during percutaneous nephrolithotomy. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00071-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To assess Impact of weight on stone-free rate during percutaneous nephrolithotomy.
Methods
Hundred and twenty-three PNL procedures were done between January 2016 and July 2017. The patients were divided into four groups according to the World Health Organization (WHO) classification of body mass index (BMI): < 25 ((group 1, average)), 25–29.9 (group 2, overweight), 30–39.9 (group 3, obese), and ≥ 40 kg/m2 (group 4, morbidly obese). All groups were compared as regarding preoperative variables, intra-operative procedure and postoperative results.
Results
The non-obese groups were younger in age than obese and morbid obese groups (P = 0.005). The difference in BMI was statistically significant between non-obese and obese groups (P = 0.0001). Most of females gender were obese and morbid obese (P = 0.0001) and most of the obese patients had left-sided renal stone (P = 0.001). Most of overweight and obese groups had radiopaque stones (P = 0.02). There were no statistically significant differences between all groups as regarding co-morbidity, stone size, stone locations, and hydronephrosis grade. Operative time (P = 0.034), length of hospital stay (P value = 0.014) and fluoroscopy time (P = 0.0001) were statistically significant differences between all groups. Number of accesses, access site, postoperative hemoglobin drop, post- operative complications, fate of residual stones and stone-free rate were not statistically significant differences between all groups. BMI was correlated with mean fluoroscopy time and mean hospitalization duration in our study as the time of hospitalization and time of x-ray exposure increase with obesity.
Conclusion
PNL is a safe and effective procedure for obese patients. BMI do not predict clearance post PNL.
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Karsli O, Ustuner M, Voyvoda B, Memik O, Halat AO, Ozcan L. A new percutaneous nephrolithotomy position in horseshoe kidney: 45 degrees sided prone. Cent European J Urol 2020; 73:349-354. [PMID: 33133664 PMCID: PMC7587488 DOI: 10.5173/ceju.2020.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/18/2020] [Accepted: 07/23/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION In this study we aimed to determine the effects of the 45 degrees sided prone position to the surgeon's comfort, operation time, fluoroscopy time and complications at the operation of percutaneous nephrolithotomy (PCNL) for the treatment of kidney stone of horseshoe kidney (HK) or rotation anomaly kidney. MATERIAL AND METHODS Thirty eight patients (25 male, 13 female) with renal calculi and HK, underwent PCNL. After the amplatz sheath was inserted into the collecting system, the patients in group 1 (n:20) were taken to the 45 degrees side position to the side of the operation and patients in group 2 (n:18) were operated in classical prone position. Operative data of two groups were compared statistically. RESULTS Mean stone size of group 1 was 557.8 ±244.8 mm3 (188-1175) and group 2 was 590.7 ±172.8 mm3 (423-909) (p = 0.639). In group 1 mean operation time was 78.6 ±21.8 (45-120) minutes and in group 2 was 95.05 ±11.5 (69-120) minutes. The difference for operation time was statistically significant and shorter in the sided group (p = 0.02). CONCLUSIONS The working position of rigid nephroscope is 90 degrees to the body after the dorsomedial or dorsolateral access. In our study the position of patient is laterally sided 45 degree and the flexion on the surgeon's shoulder was minimised. This new position described for PCNL in HK allows comfortable working position for surgeon after upper pole posterior calyces access.
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Affiliation(s)
- Onur Karsli
- Health Sciences University, Derince Training and Research Hospital, Department of Urology, Kocaeli, Turkey
| | - Murat Ustuner
- Health Sciences University, Derince Training and Research Hospital, Department of Urology, Kocaeli, Turkey
| | - Bekir Voyvoda
- Health Sciences University, Derince Training and Research Hospital, Department of Urology, Kocaeli, Turkey
| | - Omur Memik
- Health Sciences University, Derince Training and Research Hospital, Department of Urology, Kocaeli, Turkey
| | - Ahmed Omer Halat
- Health Sciences University, Derince Training and Research Hospital, Department of Urology, Kocaeli, Turkey
| | - Levent Ozcan
- Health Sciences University, Derince Training and Research Hospital, Department of Urology, Kocaeli, Turkey
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Ahmed AF, Gomaa A, Daoud A, Solyman A, Abdelazim H, El-Feky M, Agha M, Abdellatif A, Fahim A. Split-leg modified lateral versus prone position in percutaneous nephrolithotomy: a prospective, randomized trial. World J Urol 2020; 39:1247-1256. [PMID: 32488361 DOI: 10.1007/s00345-020-03285-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Standard prone position (PP) during percutaneous nephrolithotomy (PNL) has multiple drawbacks. We aimed to compare PNLs performed in split-leg (SL) modified lateral position (MLP) and those performed in standard PP. METHODS A prospective, randomized, unblind, double arm trial was conducted at a tertiary care academic medical center in Egypt, between November 2017 and October 2019. Adult patients with renal stones undergoing PNL were included. According to renal anatomy and stone complexity, stratified randomization was performed and study participants were allocated into either SL-MLP group or PP group. The stone free rate (SFR), total operative time, track formation time, fluoroscopy time, auxiliary procedures, and complications were compared. RESULTS There were 61 patients in SL-MLP group and 63 patients in PP group. Both groups had similar baseline characteristics. The SFR was comparable between groups: 75.4% in SL-MLP group and 77.8% in PP group (p = 0.755). The mean total operative time was shorter and mean track formation time was longer in SL-MLP group (55.33 ± 20.73 vs. 98.49 ± 9.23, p < 0.001 and 7.89 ± 3.68 vs. 6.52 ± 1.77, p = 0.002). There was no significant difference in fluoroscopy time, total complication rates, hemoglobin reduction and need for blood transfusion between the groups. In SL-MLP group, all PNL procedures as well all the associated procedures were performed with the patients in the same position. CONCLUSION SL-MLP PNL has a short operative time and similar SFR and complication rate compared to PP PNL. SL-MLP allowed antegrade and retrograde access to the urinary tract without patient repositioning.
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Affiliation(s)
- Abul-Fotouh Ahmed
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
| | - Ahmed Gomaa
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdullah Daoud
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Solyman
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hassan Abdelazim
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohammed El-Feky
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohammed Agha
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.,Department of Urology, Saudi German Hospital, Asir, Saudi Arabia
| | - Ashraf Abdellatif
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.,Department of Urology, Al-Hamady Hospital, Riyadh, Saudi Arabia
| | - Ahmed Fahim
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Chu IEH, Ranasinghe W, Jones MN, McCahy P. Prone versus modified supine percutaneous nephrolithotomy: which is more cost effective in an Australian tertiary teaching hospital? JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415818817131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Percutaneous nephrolithotomy is currently one of the main treatment options for large renal stones, but the effect of positioning on comparative costing has been scarcely documented. We aimed to compare the cost effectiveness of modified supine with traditional prone percutaneous nephrolithotomy procedures in the context of Victoria, Australia. Materials and methods: A prospective group of 236 renal units (224 patients) was included in the two-site study, with 76 performed in the prone position and 160 performed in the modified supine position. Costing was calculated using a ‘bottom-up’, all-inclusive framework that generates per-hour costs for theatre, recovery unit and ward costs from base costs and maintenance costs. Percutaneous nephrolithotomy-specific equipment was added to calculate comparative costs of modified supine versus prone procedures. Chi squared and T tests were used for statistical analysis. Results: There was a significant difference in the overall costing between the modified supine and prone groups. The modified supine group had a lower total cost (AUD$6424.29) compared to the prone group (AUD$7494.79) ( P=0.007), lower operative costs (AUD$4250.93 vs. AUD$5084.29, P=0.002) and lower ward costs (AUD$533.55 vs. AUD$1130.20, P<0.001). There was no significant difference in recovery times in the modified supine and prone groups, although the modified supine group appeared to have shorter recovery times (AUD$690.69 vs. AUD$586.05, P=0.209). Conclusions: Modified supine percutaneous nephrolithotomy has significantly lower total costs, operative costs and ward costs compared to prone percutaneous nephrolithotomy. Larger randomised trials are needed to assess these findings further. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
| | | | | | - Philip McCahy
- Department of Surgery, Monash University, Australia
- Casey Hospital, Berwick, Monash Health, Australia
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Ozdemir H, Erbin A, Sahan M, Savun M, Cubuk A, Yazici O, Akbulut MF, Sarilar O. Comparison of supine and prone miniaturized percutaneous nephrolithotomy in the treatment of lower pole, middle pole and renal pelvic stones: A matched pair analysis. Int Braz J Urol 2019; 45:956-964. [PMID: 31408287 PMCID: PMC6844341 DOI: 10.1590/s1677-5538.ibju.2019.0049] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 04/01/2019] [Indexed: 12/02/2022] Open
Abstract
Purpose We aimed to compare the outcomes of supine and prone miniaturized percutaneous nephrolithotomy (m-PNL) in the treatment of lower pole, middle pole and renal pelvic stones. Materials and Methods 54 patients who performed supine m-PNL between January 2017 and March 2018 and 498 patients who performed prone m-PNL between April 2015 and January 2018 were included in the study. Of the 498 patients, 108 matching 1: 2 in terms of age, gender, body mass index, American Association of Anesthesiology score, stone size, stone localization and hydronephrosis according to the supine m-PNL group were selected as prone m-PNL group. The patients with solitary kidney, upper pole stone, urinary system anomaly or skeletal malformation and pediatric patients (<18 years old) were excluded from the study. The success was defined as ‘complete stone clearance’ and was determined according to the 1st month computed tomography. Results The operation time and fluoroscopy time in supine m-PNL was significantly shorter than prone m-PNL group (58.1±45.9 vs. 80.1±40.0 min and 3.0±1.7 min vs. 4.9±4.5 min, p=0.025 and p=0.01, respectively). When post-operative complications were compared according to the modified Clavien-Dindo classification, overall and subgroup complication rates were comparable between groups. There was no significant difference between the groups in terms of the success rates (supine m-PNL; 72.2%, prone m-PNL; 71.3%, p=0.902). Conclusions Supine m-PNL procedure is more advantageous in terms of operation time and fluoroscopy time in the treatment of lower pole, middle pole and renal pelvic stones.
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Affiliation(s)
- Harun Ozdemir
- Department of Urology, Haseki Traning and Research Hospital, Istanbul, Turkey
| | - Akif Erbin
- Department of Urology, Haseki Traning and Research Hospital, Istanbul, Turkey
| | - Murat Sahan
- Department of Urology, Haseki Traning and Research Hospital, Istanbul, Turkey
| | - Metin Savun
- Department of Urology, Haseki Traning and Research Hospital, Istanbul, Turkey
| | - Alkan Cubuk
- Department of Urology, Haseki Traning and Research Hospital, Istanbul, Turkey
| | - Ozgur Yazici
- Department of Urology, Haseki Traning and Research Hospital, Istanbul, Turkey
| | | | - Omer Sarilar
- Department of Urology, Haseki Traning and Research Hospital, Istanbul, Turkey
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Melo PADS, Vicentini FC, Perrella R, Murta CB, Claro JFDA. Comparative study of percutaneous nephrolithotomy performed in the traditional prone position and in three different supine positions. Int Braz J Urol 2019; 45:108-117. [PMID: 30521168 PMCID: PMC6442131 DOI: 10.1590/s1677-5538.ibju.2018.0191] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/22/2018] [Indexed: 12/12/2022] Open
Abstract
Purpose: To compare the outcomes of percutaneous nephrolithotomy (PCNL) performed in the prone position (PRON) and in three variations of the supine position. Materials and Methods: We performed a retrospective analysis of patients that underwent PCNL at our institution from June 2011 to October 2016 in PRON and in three variations of the supine position: complete supine (COMPSUP), original Valdivia (VALD), and Galdakao - modified Valdivia (GALD). All patients had a complete pre - operative evaluation, including computed tomography (CT). Success was defined as the absence of residual fragments larger than 4 mm on the first post - operative day CT. Results: We analyzed 393 PCNLs: 100 in COMPSUP, 94 in VALD, 100 in GALD, and 99 in PRON. The overall success rate was 50.9% and was similar among groups (p = 0.428). There were no differences between groups in the number of punctures, stone - free rate, frequency of blood transfusions, drop in hemoglobin level, length of hospital stay, and severe complications (Clavien ≥ 3). COMPSUP had a significantly lower operative time than the other positions. COMPSUP had lower fluoroscopy time than VALD. Conclusion: Patient positioning in PCNL does not seem to impact the rates of success or severe complications. However, COMPSUP is associated with a shorter surgical time than the other positions.
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Affiliation(s)
| | | | - Rodrigo Perrella
- Divisão de Urologia do Centro de Saúde Masculina do Hospital Brigadeiro, São Paulo, SP, Brasil
| | - Claudio Bovolenta Murta
- Divisão de Urologia do Centro de Saúde Masculina do Hospital Brigadeiro, São Paulo, SP, Brasil
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Gupta S, Maurya AK, Pal DK. Observational prospective study for surgical outcome and anesthetic feasibility of tubeless and totally tubeless supine PCNL: A single centre initial experience. Turk J Urol 2019; 45:146-149. [PMID: 30875292 DOI: 10.5152/tud.2018.97345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 08/08/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate surgical outcome and spinal anesthetic feasibility of supine percutaneous nephrolithotomy (PCNL) by tubeless and totally tubeless method. MATERIAL AND METHODS This observational study included a totally 53 patients. Initial diagnosis of renal stone was based on urinary ultrasonography, kidney, ureter and bladder X-ray, and later confirmed by computed tomography urography. PCNL was done with the patient in Galdakao-modified supine Valdivia position. Nephrostomy was not done using tubeless method, while in totally tubeless method instead of insertion of double j stent, ureteral catheterization was done and the ureter catheter was kept for <24 hours. During postprocedural period, patients were observed for development of fever, perinephric collection, need for blood transfusion and duration of hospital stay. RESULTS Patients aged between 14 and 75 years were included in the study. Out of totally 53 patients, supine tubeless PCNL was done in 23 patients while 30 were operated using totally tubeless method. Twenty-nine patients were induced by spinal anesthesia and 24 by general anesthesia. Stone sizes were found to be in the range of 1.4cm to 5.1 cm. Forty-six (86.7%) patients were managed by inferior calyceal puncture. Three patients required double puncture in whom 2 had developed perinephric collection. Complete stone clearance achieved in 49 (92.4%) patients. Four patients developed fever and 2 cases required one unit blood transfusion postoperatively. CONCLUSION Tubeless and totally tubeless supine PCNL is technically feasible with good surgical outcomes and can be done under spinal and general anesthesia in properly selected patients.
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Affiliation(s)
- Sandeep Gupta
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Arun Kuamr Maurya
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Dilip Kumar Pal
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, India
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Sharma GR, Luitel B. Techniques for fluoroscopy-guided percutaneous renal access: An analytical review. Indian J Urol 2019; 35:259-266. [PMID: 31619863 PMCID: PMC6792419 DOI: 10.4103/iju.iju_149_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Percutaneous renal access is a key step for a successful percutaneous nephrolithotomy. It involves the use of fluoroscopy, ultrasonography, or a combination of both. Over the years, various techniques have been proposed for fluoroscopy-guided access, and this article reviews the different techniques along with the anatomical principles for fluoroscopy-guided percutaneous renal access. A literature search was performed using "PubMed" for relevant literature describing the various techniques for fluoroscopy-guided percutaneous renal access. Each technique was analyzed in regard to how it describes selecting the skin site for puncture and determines the angle and depth of puncture. The advantages, limitations, and variations of these techniques were also studied. Each technique has its advantages and limitations. No study has compared all the techniques either in vivo or in vitro. Only a comparative study would establish the superiority of one technique over the other. Until this is done, endourologists should be well versed with the existing techniques.
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Affiliation(s)
| | - Bhojraj Luitel
- Department of Urology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Vicentini FC, Perrella R, Souza VMG, Hisano M, Murta CB, Claro JFDA. Impact of patient position on the outcomes of percutaneous neprolithotomy for complex kidney stones. Int Braz J Urol 2018; 44:965-971. [PMID: 30088725 PMCID: PMC6237521 DOI: 10.1590/s1677-5538.ibju.2018.0163] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/31/2018] [Indexed: 12/28/2022] Open
Abstract
Purpose: To evaluate the impact of the patient position on the outcomes of PCNL among patients with complex renal stones. Material and Methods: From July 2011 to July 2014, we collected prospective data of consecutive patients who underwent PCNL. We included all patients with complex stones (Guy's Stone Score 3 or 4 (GSS) based on a CT scan) and divided them based on the position used during PCNL (prone or supine). The variables analyzed were gender, age, body mass index, ASA score, stone diameter, GSS, number of punctures, calyx puncture site, intercostal access and patient positioning. Complications were graded according to the modified-Clavien Classification. Success was considered if fragments ≤ 4mm were observed on the first postoperative day CT scan. Results: We analyzed 240 (46.4%) of 517 PCNL performed during the study period that were classified as GGS 3-4. Regarding patient positions, 21.2% were prone and 79.8% were supine. Both groups were comparable, although intercostal access was more common in prone cases (25.5% vs 10.5%; p=0.01). The success rates, complications, blood transfusions and surgical times were similar for both groups; however, there were significantly more visceral injuries (10.3% vs 2.6%; p=0.046) and sepsis (7.8% vs 2.1%; p=0.042) in prone cases. Conclusion: Supine or prone position were equally suitable for PCNL with complex stones and did not impact the success rates. However, supine position was associated with fewer sepsis cases and visceral injuries.
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Affiliation(s)
- Fabio Carvalho Vicentini
- Departamento de Urologia, Setor de Endourologia e Litíase, Hospital Brigadeiro, São Paulo, SP, Brasil
| | - Rodrigo Perrella
- Departamento de Urologia, Setor de Endourologia e Litíase, Hospital Brigadeiro, São Paulo, SP, Brasil
| | - Vinicius M G Souza
- Departamento de Urologia, Setor de Endourologia e Litíase, Hospital Brigadeiro, São Paulo, SP, Brasil
| | - Marcelo Hisano
- Departamento de Urologia, Setor de Endourologia e Litíase, Hospital Brigadeiro, São Paulo, SP, Brasil
| | - Claudio Bovolenta Murta
- Departamento de Urologia, Setor de Endourologia e Litíase, Hospital Brigadeiro, São Paulo, SP, Brasil
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PCNL in the prone position VS PCNL in the modified supine Double-S position: is there a better position? A prospective randomized trial. Urolithiasis 2018; 48:63-69. [DOI: 10.1007/s00240-018-1088-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
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Gupta S, Das SK, Pal DK. Total tubeless ultra-mini supine percutaneous nephrolithotomy: A feasibility study. Turk J Urol 2018; 44:323-328. [PMID: 29932402 DOI: 10.5152/tud.2018.48642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 03/05/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The ultra-mini percutaneous nephrolithotomy (PCNL) for treating low-volume renal nephrolithiasis is being used as an alternative modality to the conventional PCNL. However its use in the supine position has been scarcely reported. MATERIAL AND METHODS Patients who underwent ultra-mini PCNL in the supine position within the time frame of January 2017 to July 2017 were studied. All these patients had this as their first-line treatment. The patients had calculus limited to either a single calyx or just extending to the pelvis and the stone size was less than 2 cm in its maximal dimension. An 8.5 Fr operating nephroscope was used. The patients were positioned in the Galdakao modified Valdivia supine position. The stones were fragmented using Holmium-YAG laser. Various surgical outcomes including duration of the surgery, stone-free rate and any subsequent complications-if any-were analyzed. RESULTS The study includes a series of 14 patients with 15 renal units (one patient treated with bilateral renal stone disease). The mean age of the patients was 39.07 years and body mass index was 25.5 kg/m2. Intrarenal stone location was as follows: lower calyx, n=8; middle calyx, n=3, upper calyx, n=1, and pelvis, n=3. Median operative time was 52.66 min (range: 40-70) and the stone-free rate was 93.3%. Only one patient had residual fragments and needed subsequent extracorporeal shock wave lithotripsy. CONCLUSION Ultra-mini PCNL in supine position with a complete tubeless approach for renal stone disease is a safe method for treating low-volume disease. Studies with a larger cohort may be required to finally validate this technique.
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Affiliation(s)
- Sandeep Gupta
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Susanta Kumar Das
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Dilip Kumar Pal
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, India
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Supine Percutaneous Nephrolithotripsy in Double-S Position. Adv Urol 2018; 2018:7193843. [PMID: 29713340 PMCID: PMC5866850 DOI: 10.1155/2018/7193843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 12/18/2017] [Accepted: 01/08/2018] [Indexed: 11/17/2022] Open
Abstract
Background At present, the percutaneous nephrolithotripsy (PCNL) is performed both in supine and in prone position. The aim of this paper is to describe an innovative position during PCNL. Methods We describe a supine position. The patient's legs are slightly abducted at the hips. The thorax is laterally tilted (inclination 30°–35°) and kept in the right position by one or two gel pads placed between the scapula and the vertebrae. External genitalia can be accessed at any time, so that it is always possible to use flexible instruments in the upper urinary tract. We used this position for a period of 12 months to treat with PCNL 45 patients with renal lithiasis. Results All the procedures were successfully completed without complications, using the position we are describing. The following are some of its benefits: an easier positioning of the patient; a better exposure of the flank for an easier access to the posterior renal calyces of the kidney; a lower risk of pressure injuries compared to positions foreseeing the use of knee crutches; the possibility of combined procedures (ECIRS) through the use of flexible instruments; and a good fluoroscopic visualization of the kidney not overlapped by the vertebrae. Conclusions This position is effective, safe, easy, and quick to prepare and allows for combined anterograde/retrograde operations.
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Radiologic Relation of the Colon to the Trajectory of Percutaneous Nephrolithotomy Access in Prone Versus Flank-free Modified Supine Position: A Prospective Study of Intra and Interindividual Influencing Factors. Urology 2018; 115:71-75. [DOI: 10.1016/j.urology.2018.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/14/2018] [Accepted: 02/17/2018] [Indexed: 01/11/2023]
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de Souza Melo PA, Vicentini FC, Beraldi AA, Hisano M, Murta CB, de Almeida Claro JF. Outcomes of more than 1 000 percutaneous nephrolithotomies and validation of Guy's stone score. BJU Int 2018; 121:640-646. [PMID: 29322602 DOI: 10.1111/bju.14129] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To present the experience with percutaneous nephrolithotomy (PCNL) at a high-volume Brazilian centre and to evaluate Guy's stone score (GSS) as a predictor of success and complications in PCNL. PATIENTS AND METHODS We prospectively evaluated patients who underwent PCNL between June 2011 and October 2016. Indications for PCNL included renal stones >2 cm in size and stones <2 cm in size in which first-line techniques had failed. All patients underwent a complete preoperative evaluation, including non-contrast-enhanced abdominal computed tomography (CT). Stone complexity was assessed using GSS. Success was defined as the absence of fragments >2 mm on CT on postoperative day 1. Complications were classified according to the Clavien grade. RESULTS A total of 1 066 PCNLs were performed on 891 patients. In all, 20.2% were classified as GSS1, 27.4% as GSS2, 35.0% as GSS3, and 17.4% as GSS4. The mean operating time was 108.44 min, and the mean fluoroscopy time was 13.57 min. The overall immediate success rate based on postoperative day 1 CT was 43.8%. Complications occurred in 14.9% of cases, and the mean length of hospital stay was 54.55 h. Stratifying patients according to GSS, success rate was inversely proportional to the calculus complexity: GSS1: 87.9%; GSS2: 62.1%; GSS3: 44.0%; and GSS4: 24.3% (P < 0.001). Higher GSS categories were significantly correlated with the number of puncture tracts (P < 0.001), operating time (P < 0.001), fluoroscopy time (P < 0.001), blood transfusion rate (P < 0.001), complications (P < 0.001) and length of stay (P < 0.001). CONCLUSION In a high-volume centre, PCNL was a reliable surgical technique, with low morbidity and short hospital stay. GSS was confirmed to be a very useful tool for predicting the outcomes of PCNL, and its use should be encouraged.
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Affiliation(s)
| | | | | | - Marcelo Hisano
- Division of Urology, Men's Health Centre, Hospital Brigadeiro, Sao Paulo, SP, Brazil
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Percutaneous nephrolithotomy: position, position, position! Urolithiasis 2017; 46:79-86. [DOI: 10.1007/s00240-017-1019-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 11/11/2017] [Indexed: 01/31/2023]
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Amón Sesmero JH, Cepeda Delgado M, de la Cruz Martín B, Mainez Rodriguez JA, Alonso Fernández D, Rodriguez Tesedo V, Martín Way DA, Gutiérrez Aceves J. Small-calibre percutaneous nephrolithotomy (SC-PCNL). Therapeutic decision algorithm. Actas Urol Esp 2017; 41:552-561. [PMID: 28392115 DOI: 10.1016/j.acuro.2016.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/20/2016] [Accepted: 11/21/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The progressive reduction in the calibre of the tract in percutaneous kidney surgery to the point of miniaturisation has expanded its use to smaller stones that until now have been treated with extracorporeal shock wave lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS). OBJECTIVE To provide an update on the various techniques of small-calibre nephrolithotomy (SC-PCNL) analyse their efficacy, safety and indications and determine their degree of implantation at this time. MATERIAL AND METHODS We performed a review in PubMed of Spanish and English medical literature on the various techniques of SC-PCNL. RESULTS The use of SC-PCNL has reduced the morbidity associated with standard PCNL, particularly bleeding, and has enabled tubeless nephrolithotomy with greater safety. There are various techniques with blurred terminology (Miniperc, Microperc, Mini-microperc, Ultraminiperc), which differ in terms of gauge employed and in certain technical aspects that require their indications be specified. Currently, SC-PCNL competes with techniques that are less invasive than standard PCNL such as ESWL and the RIRS in treating small stones, but the role of SC-PCNL is still not sufficiently understood and continues to be the subject of debate. CONCLUSIONS The indications for PCNL are expanding to small stone sizes due to the miniaturisation of the technique. PCNL competes in this field with ESWL and RIRS. Larder studies are needed to establish the specific indications for PCNL in treating nephrolithiasis.
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Affiliation(s)
- J H Amón Sesmero
- Servicio de Urología, Hospital Universitario Río Hortega. Valladolid, España.
| | - M Cepeda Delgado
- Servicio de Urología, Hospital Universitario Río Hortega. Valladolid, España
| | - B de la Cruz Martín
- Servicio de Urología, Hospital Universitario Río Hortega. Valladolid, España
| | | | - D Alonso Fernández
- Servicio de Urología, Hospital Universitario Río Hortega. Valladolid, España
| | - V Rodriguez Tesedo
- Servicio de Urología, Hospital Universitario Río Hortega. Valladolid, España
| | - D A Martín Way
- Servicio de Urología, Hospital Universitario Virgen de la Nieves, Granada, España
| | - J Gutiérrez Aceves
- Department of Urology, Wake Forest Baptist Medical Center , Winston Salem, North Carolina, EE. UU
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Nkwam N, Khan MA. Modified supine percutaneous nephrolithotomy with combined fluoroscopy and ultrasound-guided renal puncture: Initial single-surgeon experience at a UK teaching hospital. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415817704127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The purpose of this article is to report the outcomes of our initial experience of performing percutaneous nephrolithotomy in the supine position using ultrasound guidance in addition to fluoroscopy for renal access. Patients and methods: The first 34 consecutive modified supine percutaneous nephrolithotomy cases performed by a single consultant urologist inserting their own percutaneous tracts using ultrasound-guidance and fluoroscopy were evaluated. Operative data was collected prospectively over a 10-month period including any complications. The stone-free rate was evaluated three months post-operatively with a plain film or non-contrast computed tomography of the kidneys, ureters and bladder. Results: Renal access was achieved in all 34 cases. Mean age was 57 years (19–82) with 14 males and 20 females. Mean stone size 37.2 mm (20–72 mm). Overall stone-free rate was 85.3% at a mean follow up of 11.2 months. There was one Clavien Grade I, and three Clavien Grade II complications of post-operative fever requiring treatment with intravenous antibiotics. No patients developed urosepsis, required blood transfusion or sustained any visceral injury. Median in-patient stay was one night (1–4). Conclusion: Modified supine percutaneous nephrolithotomy with combined fluoroscopy and ultrasound-guided renal access has a low incidence of complications allowing for short hospital stay.
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Affiliation(s)
- N Nkwam
- Department of Urology, Leicester General Hospital, UK
| | - MA Khan
- Department of Urology, Leicester General Hospital, UK
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Falahatkar S, Allahkhah A, Kazemzadeh M, Enshaei A, Shakiba M, Moghaddas F. Complete supine PCNL: ultrasound vs. fluoroscopic guided: a randomized clinical trial. Int Braz J Urol 2017; 42:710-6. [PMID: 27564281 PMCID: PMC5006766 DOI: 10.1590/s1677-5538.ibju.2014.0291] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 10/12/2015] [Indexed: 12/28/2022] Open
Abstract
Introduction and Hypothesis: To compare complications and outcomes of complete supine percutaneous nephrolithotomy (csPCNL) with ultrasound guided and fluoroscopically guided procedure. Materials and Methods: In this randomized clinical trial study from January 2009 to September 2010, 26 of 51 patients with renal stones underwent csPCNL with ultrasonographic guidance in all steps of the procedure (group A), and the other 25 patients underwent standard fluoroscopically guided csPCNL (group B). All of the patients underwent PCNL in the complete supine position. Statistical analysis was performed with SPSS16 software. Results: Mean BMI was 28.14 in group A and 26.31 in group B (p=0.30). The mean stone burden was 26.48 and 30.44 in groups A and B, respectively (p=0.20). The stone free rate was 88.5% in group A and 75.5% in group B, that was no significant (p=0.16). Overall 2 patients (7.7%) in group A and 6 patients (24%) in group B had complications (p=0.11). Mean operative time in group A was 88.46 minutes, and in group B it was 79.58 minutes (p=0.39). Mean hospital stay was 69.70 and 61.79 hours in group A and B, respectively (p=0.22). There was no visceral injury in groups. Conclusions: This randomized study showed that totally ultrasonic had the same outcomes of fluoroscopically csPCNL. Ultrasonography can be an alternative rather than fluoroscopy in PCNL. We believe that more randomized studies are needed to allow endourologists to use sonography rather than fluoroscopy in order to avoid exposition to radiation.
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Affiliation(s)
- Siavash Falahatkar
- Urology Research Center, Guilan University of Medical Sciences, Guilan, Iran
| | - Aliakbar Allahkhah
- Urology Research Center, Guilan University of Medical Sciences, Guilan, Iran
| | - Majid Kazemzadeh
- Urology Research Center, Guilan University of Medical Sciences, Guilan, Iran
| | - Ahmad Enshaei
- Urology Research Center, Guilan University of Medical Sciences, Guilan, Iran
| | - Maryam Shakiba
- Urology Research Center, Guilan University of Medical Sciences, Guilan, Iran
| | - Fahimeh Moghaddas
- Urology Research Center, Guilan University of Medical Sciences, Guilan, Iran
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Cansino R, Portilla A, Rivas JG. Performing easy prone punction. Cent European J Urol 2017; 70:170-174. [PMID: 28721284 PMCID: PMC5510337 DOI: 10.5173/ceju.2017.932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 04/09/2017] [Accepted: 04/17/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction Percutaneous renal surgery has been considered one of the most important advances in urology. There are several possibilities to perform a kidney puncture such as using fluoroscopy, ultrasound or both. The aim of this article is to describe our puncture technique. Material and methods Correct puncture is one of the most critical and challenging steps during percutaneous surgery. Bull’s eye technique and other similar techniques supported by fluoroscopy try to make triangulations and provide different views. On the other hand, many urologists prefer the usage of ultrasound to help reach the calyx. The perfect puncture could also be a scanner guided puncture. Results Under general anesthesia, cystoscopy is performed for ureteral catheter placement. The excretory system is opacified by administering contrast to the ureteral catheter. Perpendicular puncture on the selected calyx is done; this is a 90° puncture with a fine spinal needle 20G into the selected calyx under fluoroscopy control to visualize the correct penetration into the calyx. Moving forward to the next step, an 18G needle is used to follow the correct calyx – infundibulum – renal pelvis path. The goal is to put together both tips of the 2 needles (needle Kiss technique). Conclusions After several years of performing percutaneous surgery, we conclude that our technique can facilitate the prone position puncture thanks to the information given from the thin needle while simultaneously minimizing the use of fluoroscopy for triangulation maneuvers and avoiding the use of ultrasound to determine the depth of the target calyx.
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Affiliation(s)
- Ramón Cansino
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Juan Gómez Rivas
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
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Patel RM, Okhunov Z, Clayman RV, Landman J. Prone Versus Supine Percutaneous Nephrolithotomy: What Is Your Position? Curr Urol Rep 2017; 18:26. [PMID: 28247328 DOI: 10.1007/s11934-017-0676-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Percutaneous nephrolithotomy (PCNL) is the gold standard surgical procedure for treating large, complex renal stones. Due to its challenging nature, PCNL has undergone many modifications in surgical technique, instruments, and also in patient positioning. Since the first inception of PCNL, prone position has been traditionally used. However, alternative positions have been proposed and assessed over the years. This is a comprehensive review on the latest developments related to positioning in the practice of PCNL. RECENT FINDINGS The prone position and its modifications are the most widely used positions for PCNL, but with the introduction of various supine positions, the optimal position has been up for debate. Recent meta-analysis has shown a superior stone-free rate in the prone position and comparable complication rates to the supine position. The advantage of ease of access to the urethra for simultaneous retrograde techniques in the supine position is also possible with modifications in the prone position such as the split-leg technique. Modern-day PCNL has transformed from an operation traditionally undertaken in the prone position to a procedure in which a prone or supine position may be employed; however, published data have not shown significant superiority of either approach.
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Affiliation(s)
- Roshan M Patel
- Department of Urology, University of California, Irvine, 333 City Boulevard West, Suite 2100, Orange, CA, 92868, USA.
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, 333 City Boulevard West, Suite 2100, Orange, CA, 92868, USA
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, 333 City Boulevard West, Suite 2100, Orange, CA, 92868, USA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, 333 City Boulevard West, Suite 2100, Orange, CA, 92868, USA
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Landa-Salas JD, Torres-Anguiano JR, Maldonado-Alcaraz E, Lopez-Samano VA, Serrano-Brambila EA, Moreno-Palacios J. [Stone free rate assesment after percutaneous nephrolithotomy using nephrolitometric nomogram]. CIR CIR 2017; 85:510-514. [PMID: 28433235 DOI: 10.1016/j.circir.2017.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 12/05/2016] [Accepted: 03/17/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Percutaneous nephrolithotomy remains the standard of care for kidney stones larger than 2cm. Therefore, setting a prognosis for complete stone resolution through this method is essential. The prognostic tools available have limited prediction. OBJECTIVES To evaluate the stone-free rate in patients undergoing percutaneous nephrolithotomy with the Clinical Research Office of the Endourological Society nomogram and suggest modifications to improve the classification. MATERIAL AND METHODS We analyzed a retrospective cohort of patients undergoing percutaneous nephrolithotomy applying the nephrolithometric nomogram specified. We modified the scale dividing the patients into 3groups: i from 80 to 110 points, II from 111 to 170 points, and III more than 170 points, respectively assessing the stone-free rate (Kruskall-Wallis test was performed, p<0.05). RESULTS A total of 126 patients were included. According to the nehrolithometric nomogram the stone-free rate was 12.5% for patients with fewer than 111 points and 70.9% for those with 111 points or more. In the modification proposed for groups I, IIand III the stone-free rate was 12.5%, 50% and 80% respectively (p=0.000). CONCLUSIONS Evaluation using the nephrolithometric nomogram demonstrated accurate stone-free rate prediction for complex and simple stones, with a lack of discrimination for patients with intermediate scores. Our modification enabled better differentiation of the intermediate groups from the high and low stone-free rate groups.
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Affiliation(s)
- Jason Damián Landa-Salas
- Servicio de Urología, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Juan Ramón Torres-Anguiano
- Servicio de Urología, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Efraín Maldonado-Alcaraz
- Servicio de Urología, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | | | | | - Jorge Moreno-Palacios
- Servicio de Urología, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Ciudad de México, México.
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