1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Li P, Ma Y, Liao B, Jin X, Xiang L, Li H, Wang K. Comparison of safety and efficacy of different positions in percutaneous nephrolithotomy: a network meta-analysis. Int J Surg 2024; 110:2411-2420. [PMID: 38445503 PMCID: PMC11020106 DOI: 10.1097/js9.0000000000001130] [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: 09/26/2023] [Accepted: 01/23/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVES Various new positions for percutaneous nephrolithotomy (PCNL) were proposed to reduce the limitations of the traditional position. This study was aimed to evaluate the efficacy and safety of the different PCNL positions. METHODS PubMed, Embase, Web of Science, and the Cochrane Library were searched for relevant randomized controlled trials (RCTs) up to 18 April 2023. The authors collected five common surgical positions used for PCNL: oblique supine position (OSP), supine position (SP), flank position (FP), split-leg oblique supine/flank position (SLP), and prone position (PP). Paired and network meta-analysis were conducted to compare relevant outcomes, including complications, operative time, stone-free rates, hospital stay, and hemoglobin loss among these different positions. RESULTS The study included 17 RCTs with a total of 1841 patients. The result demonstrated that SLP significantly outperformed in terms of decreasing operation time (FP vs SLP MD- MD-41.65; OSP vs SLP MD 28.97; PP vs SLP MD 34.94), hospital stay, and hemoglobin loss. Ranking probabilities showed SLP had highest stone-free rate. Prone position was more likely to occur complications than others. Based on SMAA model, the benefit-risk analysis suggested the SLP was the optimal position in PCNL. CONCLUSIONS For PCNL, the split-leg, flank, supine, and OSPs are as secure as the prone position. Further RCTs are necessary to confirm the outstanding safety and efficacy of split-leg position. Besides, the position should be selected regard for the patient's demands, the surgeon's preference and learning curve.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Kunjie Wang
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, People Republic of China
| |
Collapse
|
3
|
Jiang Y, Sheng Y, Zhang J, Jiang Y, Shan H, Kang N. Feasibility of Simultaneous Bilateral Endoscopic Surgery in Prone Split-Leg Position for Bilateral Upper Urinary Tract Calculi: A Pilot Study. Urol Int 2024; 108:190-197. [PMID: 38290486 DOI: 10.1159/000536545] [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: 11/12/2023] [Accepted: 01/09/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION We explored the viability of simultaneous bilateral endoscopic surgery (SBES) in the prone split-leg position for managing bilateral calculi. METHODS We retrospectively reviewed 72 patients who underwent SBES, with procedures involving ureteroscopy (URS) and contralateral percutaneous nephrolithotomy (PNL) simultaneously, in prone split-leg position. RESULTS Operative times averaged 109.38 ± 30.76 min, with an average hospital stay of 7.79 ± 3.78 days. The bilateral stone-free rate (SFR) was 70.83%, while URS and PNL demonstrated comparable unilateral SFR (83.33% and 79.17%, respectively). Receiver operating characteristics curves for predicting unilateral residual fragments yielded an area under the curve of 0.84 (URS) and 0.81 (PNL) with respective cutoff values of stone diameter of 11.55 mm and 23.52 mm. Fifty-seven (79.17%) and 15 (20.83%) patients encountered grade 0-1/2 complications, with no severe complications (grade 3-5) recorded. No significant changes in blood count or renal function were observed post-SBES. CONCLUSIONS SBES in the prone split-leg position is a viable option for managing bilateral upper tract urolithiasis. Larger scale studies are needed to further assess safety and efficacy in various positions.
Collapse
Affiliation(s)
- Yihang Jiang
- Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Yali Sheng
- Department of Pharmacy, Beijing Hospital, National Center of Gerontology, Beijing, China
- Department of Pharmacy, Beijing Hospital, National Center of Gerontology, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), Beijing, China
| | - Junhui Zhang
- Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Yuguang Jiang
- Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Hui Shan
- Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Ning Kang
- Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Ding X, Hou Y, Wang C, Wang Y. Super-stiff guidewire or loach guidewire during percutaneous nephrolithotomy? BJUI COMPASS 2023; 4:562-567. [PMID: 37636203 PMCID: PMC10447211 DOI: 10.1002/bco2.219] [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: 04/25/2022] [Revised: 12/08/2022] [Accepted: 12/19/2022] [Indexed: 08/29/2023] Open
Abstract
Objectives The objectives of this work are to compare the outcomes between loach guidewire and super-stiff guidewire during percutaneous nephrolithotomy (PCNL) and find potential indications of different guidewires. Patients and methods We retrospectively reviewed our institutional PCNL database from 2017 to 2021. Patients who underwent PCNL guided by loach guidewire were assigned to group A (489 patients); patients who received super-stiff guidewire were assigned to group B (269 patients). Preoperative demographic data, intraoperative parameters, and postoperative complications were compared. The conditions and reasons of failed placement of guidewire needed readjustment were evaluated as well. Results Preoperative demographic data and most intraoperative parameters were not statistically different between the groups. Postoperative Clavien-Dindo complications were also comparable, with low rate of complications. However, failed placement of guidewire more occurred in group A (8.2% vs. 4.0%, respectively, p = 0.03). Compared with the super-stiff guidewire, the loach guidewire was easier pass/slip into any place either it be perinephric or blood vessels. In most failed group A cases and all failed group B cases, the guidewire was placed in the perirenal fat. Six patients (15%) in group A, the guidewires entered into vessels. Conclusions Our results support that the faulty placement of loach guidewire is significantly more common compared with super-stiff guidewire. Double confirmation is needed to prevent a major complication out of wrong dilatation whenever there is doubt about the wrong location of the guidewire.
Collapse
Affiliation(s)
- Xiaobo Ding
- Department of RadiologyFirst Hospital of Jilin UniversityChangchunChina
| | - Yuchuan Hou
- Department of UrologyFirst Hospital of Jilin UniversityChangchunChina
| | - Chunxi Wang
- Department of UrologyFirst Hospital of Jilin UniversityChangchunChina
| | - Yanbo Wang
- Department of UrologyFirst Hospital of Jilin UniversityChangchunChina
| |
Collapse
|
6
|
Kucukyangoz M, Gucuk A. Which position is more advantageous for percutaneous nephrolithotomy: supine or prone? Urolithiasis 2023; 51:102. [PMID: 37578662 DOI: 10.1007/s00240-023-01474-y] [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: 05/10/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
Percutaneous nephrolithotomy (PNL) can be performed in a number of different positions. Our aim was to evaluate the convenience and advantages of the supine position following the transition from the prone to the supine position. 94 patients undergoing supine PNL (Group-1) and 93 patients undergoing prone PNL (Group-2) were retrospectively reviewed and included in the study. Patients who underwent mini-PNL (mPNL) were selected from Group-1 and Group-2 and divided into Group-1A supine mPNL patients (77) and Group-2A prone mPNL patients (53). Demographic characteristics, operative data and post-operative parameters were compared between these groups. The operation time was 74.4 ± 21.9 min in Group-1A and 79.2 ± 19.8 min in Group-2A (p = 0.076). The median value of fluoroscopy time was 30 s in Group-1A and 40 s in Group-2A (p = 0.003). In Group-1A, 59 patients had no intraoperative double-J stent (DJS) insertion and 18 patients had DJS insertion, while in Group-2A, 24 patients had no DJS insertion and 29 patients had DJS insertion (p < 0.001). MPNL was performed in 81.9% of patients in the supine position and 57% in the prone position. This difference was statistically significant (p < 0.001). No significant difference was found with regard to the success rate and the complications of mPNL. Fluoroscopy time is shorter in the supine position. Moreover, the insertion rates of DJS are low. With increasing experience, we have found that our standard PNL (sPNL) rate is gradually decreasing and more mPNL is being performed.
Collapse
Affiliation(s)
| | - Adnan Gucuk
- Department of Urology, Private Acıbadem Hospital, Eskişehir, Turkey
| |
Collapse
|
7
|
Hamamoto S, Inoue T, Okada S, Taguchi K, Yasui T. Application of ultrasound imaging in the treatment of urinary tract stones. J Med Ultrason (2001) 2023:10.1007/s10396-023-01343-6. [PMID: 37572224 DOI: 10.1007/s10396-023-01343-6] [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: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 08/14/2023]
Abstract
Urinary tract stones are a common clinical condition that affect millions of individuals worldwide. The management of these stones has evolved significantly over the past 70 years, and ultrasound imaging has emerged as a valuable tool for diagnosis, treatment planning, and follow-up. This review aims to provide an overview of the application of ultrasound imaging in the treatment of urinary tract stones, highlighting its advantages, limitations, and current advancements in the field.
Collapse
Affiliation(s)
- Shuzo Hamamoto
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
- SMART Study Group, Nagoya, Japan.
| | - Takaaki Inoue
- Department of Urology, Hara Genitourinary Hospital, Hyogo, Japan
- SMART Study Group, Nagoya, Japan
| | - Shinsuke Okada
- Department of Urology, Gyotoku General Hospital, Chiba, Japan
- SMART Study Group, Nagoya, Japan
| | - Kazumi Taguchi
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Takahiro Yasui
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| |
Collapse
|
8
|
Tempo JA, Williams GM, Robertson IK, Rama DJ, Pascoe CEA, Cetti RJ. Assessing the Variability of the Twelfth Rib as a Landmark for Percutaneous Nephrolithotomy Using Computed Tomography. Res Rep Urol 2023; 15:355-363. [PMID: 37554929 PMCID: PMC10406120 DOI: 10.2147/rru.s409414] [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: 03/09/2023] [Accepted: 07/01/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND The variability in length of the twelfth rib is mentioned in the literature but has never been formally studied. The highly variable rib length provides a challenge for urologists seeking a consistent landmark for Percutaneous Nephrolithotomy (PCNL). We set out to determine whether the twelfth rib is safe to use as a consistent landmark for surgery. METHODS Single centre, cross-sectional retrospective observational study and analysis of CT scans of 100 adults who had imaging between 23rd March and 12th April 2020. The distance from the mid-sagittal line to the twelfth rib tip in the axial plane was measured as was the distance from the twelfth rib tip to the kidney, spleen and liver. RESULTS Length from the mid-sagittal line to the right twelfth rib tip varied from 46 (percentile 95% CI 40 to 57) to 136mm (percentile 95% CI 133 to 138). On the left, the distances varied from 55 (percentile 95% CI 50 to 64) to 134mm (percentile 95% CI 131 to 135). Twenty-three percent of people had an organ lying between the tip of the twelfth rib and the kidney on the right and 11% on the left. CONCLUSION The twelfth rib is highly variable in length. Similar variability was recorded in the distance from the tip to intra-abdominal organs. Due to the frequency of organs lying between the tip of the rib and the kidney it should not be used as a landmark for accessing the kidney without prior knowledge of an individual patient's anatomy as seen on imaging.
Collapse
Affiliation(s)
- Jake A Tempo
- Department of Urology, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Georgina M Williams
- Department of Urology, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Iain K Robertson
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Clifford Craig Foundation, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Darren J Rama
- Department of Urology, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Claire E A Pascoe
- Department of Urology, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Richard J Cetti
- Department of Urology, Launceston General Hospital, Launceston, Tasmania, Australia
| |
Collapse
|
9
|
Lotan P, Goldberg H, Nevo A, Darawsha AE, Gefen S, Criederman G, Rubinstein R, Herzberg H, Holland R, Lifshitz D, Golomb D. Post-operative pain following percutaneous nephrolithotripsy- clinical correlates. Urologia 2023; 90:503-509. [PMID: 36326155 DOI: 10.1177/03915603221130899] [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: 07/20/2023]
Abstract
OBJECTIVES Management of postoperative pain following percutaneous nephrolithotripsy (PCNL) is a significant goal. We sought to identify risk factors and clinical correlates of postoperative pain in order to improve perioperative management and patient satisfaction. MATERIALS AND METHODS A single-center, retrospective analysis, from a prospectively maintained database, of all consecutive patients who underwent PCNL for renal calculi between January 2011 and August 2018. Postoperative pain was assessed using the visual analog scale (VAS) and analgesic use. We considered VAS score above 4 as meaningful. Pain management was standardized according to patirnt reported VAS scores. Multivariable logistic regression was performed to identify risk factors and clinical correlates. RESULTS A total of 496 patients were analyzed. Younger age was associated with VAS above 4 on the operative day and the first postoperative following PCNL (p = 0.003 and p < 0.001, respectively). Female gender was associated with VAS above 4 in the first 2 days following the operation (p < 0.001). CONCLUSIONS Younger age and female gender would most likely benefit from pre-emptive improved pain management protocols following PCNL.
Collapse
Affiliation(s)
- Paz Lotan
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Hanan Goldberg
- Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Amihay Nevo
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | | | - Sheizaf Gefen
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | | | - Roy Rubinstein
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Haim Herzberg
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Ronen Holland
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - David Lifshitz
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Dor Golomb
- Department of Urology, Assuta Ashdod University Hospital, Ashdod, Israel
| |
Collapse
|
10
|
Kannan D, Quadri M, Sekaran PG, Paul R, Panneerselvam A, Jain N. Supine Versus Prone Percutaneous Nephrolithotomy (PCNL): A Single Surgeon's Experience. Cureus 2023; 15:e41944. [PMID: 37588325 PMCID: PMC10425827 DOI: 10.7759/cureus.41944] [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] [Accepted: 07/15/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Percutaneous nephrolithotomy (PCNL) is one of the greatest advances in the field of urology and has been considered the gold standard in the treatment of renal calculi of more than 2 cm in size. While both the supine and prone positions offer their unique advantages, it is still being debated which position offers the most in terms of surgical outcomes. We have evaluated the two approaches in terms of operative time, success rate, stone clearance rate, safety, and complications. METHODS This prospective cohort study was done in the urology department of a tertiary care center in South India between January 2018 and October 2020. A total of 166 patients, with 83 in supine and 83 in prone positions, were included in the study. RESULTS Both groups were matched in terms of age, body mass index, stone size and location, co-morbidities, medications taken, presence of diverticular stone, history of surgery, and baseline creatinine level. Mean operative time and pain scores were noted to be less in supine position as compared to prone. Ease of puncture was superior in supine position. Stone residue was noted to be higher in supine PCNL as well. CONCLUSION Supine PCNLs are preferred in high-risk patients while the prone position is preferred in bilateral PCNLs, complex anatomy, or larger stone burden.
Collapse
Affiliation(s)
| | - Mohsin Quadri
- Urology, Guntur Medical College Hospital, Guntur, IND
| | - Praveen G Sekaran
- General Surgery, Saveetha Medical College and Hospital, Chennai, IND
| | | | | | | |
Collapse
|
11
|
Yilmaz M, Sahin Y. Comparative Study of Prone Position Variations for Percutaneous Nephrolithotomy. Res Rep Urol 2023; 15:233-241. [PMID: 37383942 PMCID: PMC10296540 DOI: 10.2147/rru.s415426] [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: 04/26/2023] [Accepted: 06/05/2023] [Indexed: 06/30/2023] Open
Abstract
Objective In this comparative study, we evaluated the results of flat prone and prone hip flexed percutaneous nephrolithotomy in terms of efficacy and safety to contribute to the optimal prone percutaneous nephrolithotomy position. Materials and Methods Data of the patients who underwent percutaneous nephrolithotomy operations in a flat-prone or prone hip flexed positions due to renal pelvis and/or ≥2 Calix filling stones between January 2016 and January 2022 were collected retrospectively. Demographic data of the patient groups in different prone positions as well as clinical findings, stone characteristics and operative data were analyzed. The groups were also compared in terms of post-operative findings and complications. Results The average age and CROES scores of patients included in the study were 47.15±15.6 years and 221.76±62.49, respectively. There was no statistically significant difference between the two groups in terms of patient demographic data, stone-free status and complication rates. Operation Room Time (ORT) (min) in flat prone PCNL group was shorter in average (100.57±32.74 min vs 92.32±28.75 min, p = 0.041) and duration with nephrostomy (days) and hospitalization (days) parameters were statistically significantly shorter in prone hip flexed PCNL (respectively, p < 0.001; p = 0.005). Conclusion Flat-prone PCNL provides significantly shorter ORT. However, the time with nephrostomy and hospitalization with the prone hip flexed PCNL were shorter than flat-prone position. The findings will guide the optimal prone PCNL position.
Collapse
Affiliation(s)
- Mehmet Yilmaz
- Department of Urology, University of Health Sciences Bağcılar Training and Research Hospital, Istanbul, Turkey
| | - Yusuf Sahin
- Department of Urology, University of Health Sciences Bağcılar Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
12
|
Muacevic A, Adler JR, Deb R, Mistari W. An Observational Pilot Study on Supine Percutaneous Nephrolithotomy: Initial Experience at a Single-Centre. Cureus 2023; 15:e33597. [PMID: 36788885 PMCID: PMC9910846 DOI: 10.7759/cureus.33597] [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] [Accepted: 01/10/2023] [Indexed: 01/11/2023] Open
Abstract
Objective To assess the surgical outcome of supine percutaneous nephrolithotomy (PCNL) in patients with co-morbidities. Materials and methods We retrospectively reviewed the data of 15 patients who underwent supine PCNL at our centre from September 2019 to May 2021. Preoperatively, a complete examination of the patients, along with biochemical and radiological investigations, was done. The data, which included patient demographics, comorbidities, complexity of renal calculi, complications, and stone clearance rate, were collected from the patients' medical records. Results Patients aged between 31 and 70 years were included in the study. The mean (SD) BMI was 26.01 (2.31). Twelve patients (80%) were overweight with a BMI of 25.3 to 29.3 kg/m2. The most common comorbidities were diabetes (33.3%) and hypertension (26.7%). In our study, six patients were American Society of Anesthesiologists (ASA) grade 3 (40%), followed by grade 2 in five patients (33.3%), grade 4, and grade 1 in two patients (13.3%) each. The Guy's Stone score was one in nine patients (60%) and two in six patients (40%). Complete clearance was achieved in 13 (86.7%) patients. Two patients (13.3%) had a stone clearance of more than 80%. Data analysis showed that 14 patients (93.3%) had no perioperative complications. Postoperative abdominal distension was noted in one patient (6.7%), which was managed conservatively (Clavien-Dindo grade 1). We did not encounter any cases of organ injury following supine PCNL. Postoperatively, none of our patients received blood transfusions. Conclusion Our study shows that supine PCNL is a good surgical option, especially for high-risk patients with good stone clearance and low complication rates.
Collapse
|
13
|
Said DF, Ferreira DB, Hayek KKRE, Perrella R, Mota PKV, Cohen DJ, Batagello CA, Murta CB, Claro JFDA, Vicentini FC. Factors associated with complications after percutaneous nephrolithotomy: an analysis of 1,066 cases. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20221089. [PMID: 37194795 DOI: 10.1590/1806-9282.20221089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/23/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE The aim of this study was to identify predictive factors for complications after percutaneous nephrolithotomy. METHODS We prospectively analyzed patients who underwent percutaneous nephrolithotomy from June 2011 to October 2018. The association of preoperative and intraoperative factors with the presence of complications was assessed using univariate and multivariate analyses. The significance level was set at p<0.05. RESULTS A total of 1,066 surgeries were evaluated, and the overall complication rate was 14.9%. In all, 105 (9.8%) surgeries were performed in the prone position, and 961 (90.2%) were performed in the supine position. Univariate analysis demonstrated that surgical position, upper pole puncture, surgical time, number of tracts, and Guys Stone Score were associated with complications. In multivariate analyses, prone position (odds ratio [OR] 2.10; p=0.003), surgical time ≥90 min (OR 1.76; p=0.014), upper pole puncture (OR 2.48; p<0.001), and Guys Stone Score 3 or 4 (OR 1.90; p=0.033) were independent predictive factors for complications after percutaneous nephrolithotomy. CONCLUSION Performing percutaneous nephrolithotomy in the supine position, in under 90 min, and avoiding upper pole punctures may reduce complications during the treatment of large kidney stones.
Collapse
Affiliation(s)
- Danniel Frade Said
- Hospital de Transplantes Dr. Euryclides de Jesus Zerbini, Division of Urology - São Paulo (SP), Brazil
| | - Daniel Beltrame Ferreira
- Hospital de Transplantes Dr. Euryclides de Jesus Zerbini, Division of Urology - São Paulo (SP), Brazil
| | | | - Rodrigo Perrella
- Hospital de Transplantes Dr. Euryclides de Jesus Zerbini, Division of Urology - São Paulo (SP), Brazil
| | | | - David Jacques Cohen
- Hospital de Transplantes Dr. Euryclides de Jesus Zerbini, Division of Urology - São Paulo (SP), Brazil
| | - Carlos Alfredo Batagello
- Hospital de Transplantes Dr. Euryclides de Jesus Zerbini, Division of Urology - São Paulo (SP), Brazil
| | - Claudio Bovolenta Murta
- Hospital de Transplantes Dr. Euryclides de Jesus Zerbini, Division of Urology - São Paulo (SP), Brazil
| | | | - Fabio Carvalho Vicentini
- Hospital de Transplantes Dr. Euryclides de Jesus Zerbini, Division of Urology - São Paulo (SP), Brazil
| |
Collapse
|
14
|
Percutaneous Nephrolithotripsy in Morbidly Obese Patient: A Case Report. Case Rep Urol 2022; 2022:5899896. [PMID: 36624815 PMCID: PMC9825217 DOI: 10.1155/2022/5899896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 11/02/2022] [Accepted: 11/12/2022] [Indexed: 01/02/2023] Open
Abstract
A 50-year old male patient with morbid obesity was admitted for removal of large staghorn calculi and multiple small stones in the left kidney. The patient was managed by Percutaneous Nephrolithotomy (PCNL). Surgery was carried out in prone position and Alken's metal dilators were used for tract dilation. Alken dilators were inserted without any challenges, and the procedure was completed in a shorter span of time than anticipated with total operative time of 2 hours, including the change of positioning from lithotomy to prone. No intra-operative or post-operative complications were encountered. The patient has been followed up for 6 months post-operatively, without any complications or any evidence of stone recurrence.
Collapse
|
15
|
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.
Collapse
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
| | | |
Collapse
|
16
|
Emiliani E, Quiroz YY, Llorens E, Quintian C, Motta G, Villada D, Bujons A. Retrorenal colon in pediatric patients with urolithiasis: Is the supine position for PCNL advantageous? J Pediatr Urol 2022; 18:741.e1-741.e6. [PMID: 35985922 DOI: 10.1016/j.jpurol.2022.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Percutaneous nephrolithotomy (PCNL) is one of the main approaches for the treatment of large and complex stones in pediatric patients. The patient position for PCNL has been classically divided into prone or supine and the prone position is more commonly used. One of the most feared complications of this surgical technique is colon injury and the objective of this work is to evaluate the incidence of retrorenal colon (RRC) both supine and prone position, in pediatric patients, through radiological images. MATERIALS AND METHOD A retrosepctive review was performed of all abdominal CT scans performed in one center, in patients under 18 years since 2017 to 2019. The ideal path for percutaneous puncture was traced in the upper, middle, and lower calyces of both kidneys in the prone and supine positions and contact with the kidney and adjacent organs was evaluated, with a uro-radiologist. Chi-square test and Student's t test were applied. RESULTS 50 CT-scans were performed on 44 children. Patients had a mean age of 12.6 years and 71.4% were male. Twenty-five scans were performed in the prone and 25 in the supine position. The incidence of RRC for the left kidney (LK) was significantly higher in the lower calyx in prone position than in the supine position, 28% vs 4% (p = 0.049), and the right kidney (RK) presented RRC only in the prone position. The liver was the most frequent retrorenal organ (97.7%) for the RK, with a non-significant difference by position, while for the LK the spleen was the most frequent (61.1%). DISCUSSION Colon injury is one of the most morbid complication in PCNL and one of the reasons to perform a CT scan before surgery, on which its incidence appears to be <1% in adults. The present study revealed RRC to be present in three (12%) patients in the supine position and seven (28%) patients in the prone position (p=0.15). These results were slightly higher from those reported in adults (supine: 1.7%-10%; prone: 6.8%-20%), but there are no reports in the literature on this issue to allow appropriate comparison. This is the first study to attempt to assess the incidence of RRC in children according to position. CONCLUSION The incidence of RRC for an ideal puncture was significantly higher in the lower calyx of the left kidney in the prone position than in the supine position, and in the right kidney, the RRC only occurred in the prone position.
Collapse
Affiliation(s)
- Esteban Emiliani
- Urology Department, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Yesica Y Quiroz
- Urology Department, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Erika Llorens
- Urology Department, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | | | - Guilherme Motta
- Urology Department, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Daniela Villada
- Urology Department, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Anna Bujons
- Urology Department, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain.
| |
Collapse
|
17
|
Falahatkar S, Haghjoo P, Esmaeili S, Kazemnezhad E. Fluoroscopy screening time and radiation dose during complete supine percutaneous nephrolithotomy. World J Urol 2022; 40:2601-2607. [PMID: 36068353 DOI: 10.1007/s00345-022-04138-5] [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: 06/01/2022] [Accepted: 08/11/2022] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Fluoroscopy-guided percutaneous nephrolithotomy (PCNL) is procedure of choice for treatment of large urinary tract calculi. This study aimed to investigate the affecting factors on fluoroscopy screening time (FST) and radiation dose (RD) of patients undergoing complete supine percutaneous nephrolithotomy (csPCNL). METHODS Analytic cross-sectional study was performed on 355 patients who underwent csPCNL. The correlation between the FST and RD and patients' demographics, stone characteristics, preoperative, intraoperative and postoperative parameters were assessed. Multivariate regression analysis was used to explore various parameters which affect FST and RD. RESULTS Of all 355 patients, 191 (54.65%) were male and 161 were (45.35%) female with mean age of 48.29 ± 12.38 (16-82) years. BMI was 27.61 ± 4.53 (16.61-39.00) kg/m2. The mean operative time was 45.87 ± 18.29 min with mean FST of 101.72 ± 62.00 s. BMI, operative time, success rate, complications, stone number, and tract number had a significant relationship with FST and RD (P < 0.05). On multivariate analysis, BMI, tract number and success rate were found to be independent predictors for FST and RD. Age, gender, operation side, GFR, target calyx, lithotripsy history, stone opacity, size and site, stone configuration and distribution, and hydronephrosis did not have any correlation with FST and RD (P > 0.05). CONCLUSION BMI, success rate and tract number can be significant predictor for FST and RD during csPCNL. Identifying the affecting factors on FST and RD can help the surgeon to minimize the danger of radiation exposure by predicting and preoperative planning.
Collapse
Affiliation(s)
- Siavash Falahatkar
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Purya Haghjoo
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Samaneh Esmaeili
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnezhad
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
18
|
Watson G, Niang L, Chandresekhar S, Natchagande G, Payne SR. The feasibility of endourological surgery in low-resource settings. BJU Int 2022; 130:18-25. [PMID: 35524768 DOI: 10.1111/bju.15770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
One of the widest variations in contemporary surgical practice between high and low, or low-middle, income countries is the utilisation of endoscopy as a means of treating urological pathology. The endoscopic management of lower urinary tract problems such as benign prostatic hypertrophy, bladder cancer and urethral strictures was established in the UK in the late 1970s, whilst its adoption into everyday practice in sub-Saharan Africa has been significantly retarded. It is still neither a major feature of urological training in those countries nor widely available to the patients established consultants treat. Likewise, the explosion of less invasive technologies for treating upper tract stone disease in the 1980s, particularly the management of renal stone disease, has also lagged behind practice established in the UK over the last 40 years. This is not due to a lack of patients who could be treated endoscopically, or restricted by the abilities of the surgeons in sub-Saharan Africa. The restraint in assumption of these less-invasive management options is rather due to the physical availability of trained specialist surgeons, their access to basic infrastructure such as electricity and water, access to endoscopes and the peripheral equipment necessary to successfully deploy them and the ability of patients to afford the disposable items required for less-invasive forms of management. Some endoscopic procedures are viable in resource-poor settings. They are, however, largely dependent upon the supply of equipment from non-governmental organisations in high income countries, frugal innovation to reduce individual procedure costs, adequately skilled mentors, and maintenance and supply chains to make them a durable option in patient management. Urolink and the Medi Tech Trust present their experience of how endoscopic surgery can be taught, and used sustainably, in a resource-poor healthcare environment.
Collapse
Affiliation(s)
- Graham Watson
- East Sussex Hospitals NHS Trust, Eastbourne, UK.,Medi Tech Trust, Eastbourne, UK
| | | | | | | | | |
Collapse
|
19
|
Liu C, Zheng B, Wen J, Mao H, Jiang T, Chen Q, Chen W, Zhang H, He Y, Gao R. One-stage efficacy of single tract minimally invasive ECIRS in the improved prone frog split-leg position for staghorn stones. BMC Urol 2022; 22:54. [PMID: 35387631 PMCID: PMC8988366 DOI: 10.1186/s12894-022-01003-w] [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: 11/06/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To explore the feasibility, safety, and effectiveness of single tract minimally invasive endoscopic combined intrarenal surgery (stmECIRS) in the improved prone frog split-leg position for staghorn stones. METHOD A total of 83 patients with staghorn stones were retrospectively reviewed between January 2018 and June 2021. According to surgical procedure and position, patients were divided into a group of single tract minimally invasive percutaneous nephroscopy (stmPNL) in the prone position and a group of stmECIRS in the improved prone frog split-leg position (turned to the prone position after preset the flexible ureteroscope sheath in lithotomy position, meanwhile, bend both hips and knees to be frog abduction). Demographic characteristics, laboratory tests, stone characters, surgical information, stone-free rate (SFR), and perioperative complications were observed and analyzed. RESULTS There were no significant differences in demographic characteristics, changes level of Scr and Hb, stone size, radiation density, length of hospital stay, and operation time between the two groups. One-stage SFR in the stmECIRS group was significantly higher than that in the stmPNL group (84.4% vs. 57.9%) (P = 0.007), only 2 patients required blood transfusion after surgery (P = 0.862), and other postoperative complications were not statistically significant (P = 0.345). CONCLUSIONS StmECIRS in improved prone frog split-leg position has a higher one-stage SFR than stmPNL for staghorn renal stones, and without complications increased, which is a safe, efficient and feasible treatment.
Collapse
Affiliation(s)
- Changyi Liu
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Rd., Taijiang District, Fuzhou, Fujian, China
| | - Biqiong Zheng
- Department of Anesthesiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jinfeng Wen
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Rd., Taijiang District, Fuzhou, Fujian, China
| | - Houping Mao
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Rd., Taijiang District, Fuzhou, Fujian, China
| | - Tao Jiang
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Rd., Taijiang District, Fuzhou, Fujian, China
| | - Qin Chen
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Rd., Taijiang District, Fuzhou, Fujian, China
| | - Wenwei Chen
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Rd., Taijiang District, Fuzhou, Fujian, China
| | - Hua Zhang
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Rd., Taijiang District, Fuzhou, Fujian, China
| | - Yanfeng He
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Rd., Taijiang District, Fuzhou, Fujian, China.
| | - Rui Gao
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Rd., Taijiang District, Fuzhou, Fujian, China.
| |
Collapse
|
20
|
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: 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 & 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.
Collapse
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;
| |
Collapse
|
21
|
Supine versus prone percutaneous nephrolithotomy for renal calculi: Our experience. Curr Urol 2022; 16:25-29. [PMID: 35633854 PMCID: PMC9132181 DOI: 10.1097/cu9.0000000000000076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 07/26/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives: To compare operative times, safety, and effectiveness of percutaneous nephrolithotomy in the supine versus the prone position. Materials and methods: An observational study of 100 patients was conducted in our institution for 2years from 2018 to 2020 divided into 2 groups: 50 patients underwent modified supine percutaneous nephrolithotomy (PCNL) and 50 patients underwent standard prone PCNL. The inclusion criteria included a renal calculus (calyx or pelvis) of any size for which PCNL was indicated and exclusion criteria were patients having contraindications for PCNL such as bleeding disorders, pregnancy, high risk, and co-morbid conditions. The measured data included operative time, number of punctures, stone-free rate, length of hospital stays, and rate of complications. Results: The 2 groups were comparable in mean age, male to female ratio, calculus size, number of punctures, residual calculi, and postoperative fever and pain. The mean difference of hemoglobin in the supine PCNL group was 0.37 g/dL whereas in the prone PCNL group it was 0.61 g/dL. The p value was significant at 0.043. The mean time to finish from initial postion was 72.24 minutes in supine PCNL and 88.12 minutes in prone PCNL. The p value was significant (p < 0.001). The mean time before puncture was 20.92 minutes in the supine position and 31.84 minutes in the prone position. The p value was significant (p < 0.001). The mean time from puncture to finish was 51.32 minutes in the supine position and 56.28 minutes in the prone position. The p value was significant (p < 0.001). Conclusions: As observed from this study, supine PCNL is associated with a significantly reduced operating time when compared to conventional prone position PCNL procedures. The postoperative complications such as pain and fever were not significantly different. Hence, the supine PCNL is an equally effective modality for treatment of a renal calculus with benefits of simultaneous retrograde access and less operative time compared to the prone PCNL.
Collapse
|
22
|
Zanaty F, Mousa A, Elgharabawy M, Elshazly M, Sultan S. A prospective, randomized comparison of standard prone position versus flank-free modified supine position in percutaneous nephrolithotomy: A single-center initial experience. Urol Ann 2022; 14:172-176. [PMID: 35711483 PMCID: PMC9197000 DOI: 10.4103/ua.ua_31_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 11/19/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Percutaneous nephrolithotomy (PCNL) is the first choice for treatment of large renal stone >2 cm. The prone position is the classical position preferred by most surgeons. Aiming to improve patient anesthesia and surgery-related inconveniences of the prone position, Valdivia et al., 1987, described the performance of PCNL with the patient in the supine position. Hence, we aimed to study the safety and efficacy of flank-free modified supine position in PCNL compared to the standard prone position. Patients and Methods: This is a prospective randomized study for 60 patients with large renal stones planned for PCNL operation during the period from November 2017 to May 2019. Patients were divided into two groups (30 patients each group): Group A – patients underwent PCNL in the prone position and Group B – patients underwent PCNL in the modified flank supine position. Patients’ demographics, stone size, Hounsfield unit with intraoperative details as fluoroscopy time, operative time, and complications were recorded. Postoperatively, need for or not to blood transfusions, hospital stay, stone-free status, and postoperative complications were assessed. Results: There was no statistically significant difference between the prone and supine positions regarding stone size (4 cm vs. 4.5 cm, P = 0.16), Hounsfield unit (940 HU vs. 955 HU, P = 0.78), body mass index (31.2 kg/m2 vs. 32.5 kg/m2, P = 0.49), fluoroscopy time (6.9 min vs. 7.3 min, P = 0.5), operative time (89.5 min vs. 90.4 min, P = 0.9), residual stones (10% vs. 20%, P = 0.8), and hospital stay (45.6 h vs. 48.6 h, P = 0.5). Fever occurred in 3.3% of cases in each group and urine leakage observed in one patient with prone position. No blood transfusion was needed in both the groups. Conclusions: PCNL in the modified supine position proved to be a safe and effective choice compared to the prone position for adult patients with large renal calculi.
Collapse
|
23
|
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: 2] [Impact Index Per Article: 0.7] [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.
Collapse
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;
| |
Collapse
|
24
|
Gupta S, Sandhu A, Pal DK. Supine PCNL-5 year experience in a tertiary care center. Urologia 2021; 89:404-409. [PMID: 34697967 DOI: 10.1177/03915603211046487] [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
OBJECTIVE The prone position for percutaneous nephrolithomy (PCNL) has been widely practiced. There has been a shift from prone position to supine position which showed numerous benefits. The aim of our study is to describe the 5 year experience from the perspective of a tertiary care center using a modified Galdakao supine Valdivia position for total tubeless ultra mini supine PCNL, total tubeless supine PCNL, tubeless supine PCNL, and standard supine PCNL. MATERIAL AND METHODS We retrospectively reviewed the data of 90 patients who underwent supine PCNL at the tertiary care center during the period of 5 years from January 2017 to January 2021. The data collection was done from patients' medical records. Pre operatively, complete examination of the patients with laboratory investigations were done. The modified Clavien classification system was used to classify the perioperative complications of PCNL. RESULTS Operative time was lowest for ultra mini supine PCNL (50 ± 10.4 min) compared to standard supine PCNL (58 ± 11.2 min). Stones were single in 54 patients and multiple in 40 patients with 4 patients with staghorn stones. The size of the stones in the largest dimension ranged from 1.2 to 5.5 cm.Complete clearance was achieved in 84 (89.7%) patients. Seven patients (7.2%) developed mild fever and four patients (4.5%) required blood transfusion. CONCLUSION We found supine PCNL to be an immensely convenient, time-saving practice, and with higher stone free rate compared to prone PCNL. The different techniques of supine PCNL were also useful in patients with horseshoe kidney and calyceal diverticulum which resulted in good outcomes in these patients.
Collapse
Affiliation(s)
- Sandeep Gupta
- Department of Urology, IPGMER, Kolkata, West Bengal, India
| | - Ankit Sandhu
- Department of Urology, IPGMER, Kolkata, West Bengal, India
| | | |
Collapse
|
25
|
Hamamoto S, Okada S, Inoue T, Taguchi K, Kawase K, Okada T, Chaya R, Hattori T, Okada A, Matsuda T, Yasui T. Comparison of the safety and efficacy between the prone split-leg and Galdakao-modified supine Valdivia positions during endoscopic combined intrarenal surgery: A multi-institutional analysis. Int J Urol 2021; 28:1129-1135. [PMID: 34342062 DOI: 10.1111/iju.14655] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 07/04/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of the prone split-leg and the Galdakao-modified supine Valdivia positions during endoscopic combined intrarenal surgery. METHODS A multi-institutional, retrospective cohort study was conducted between January 2014 and December 2018. The stone-free and complication rates were compared between the prone split-leg and the Galdakao-modified supine Valdivia positions. Anatomical variations were evaluated using contrast-enhanced computed tomography imaging. RESULTS In total, 118 and 100 patients underwent endoscopic combined intrarenal surgery in the prone split-leg and Galdakao-modified supine Valdivia positions, respectively. Renal punctures in the prone split-leg position were predominantly executed through the lower calyces (78.0%), whereas those in the Galdakao-modified supine Valdivia position were primarily performed through the middle calyces (64.0%; P < 0.001). Surgical duration in the prone split-leg position was significantly shorter than that in the Galdakao-modified supine Valdivia position (106.5 vs 126.0 min; P = 0.0459). There were no significant differences in the stone-free rate between the two positions (78.8% vs 76.0%; P = 0.629). Incidences of urinary tract injury (P = 0.033) and febrile urinary tract infection (23.7% vs 10.0%; P = 0.011) in the prone split-leg position were significantly higher than that in the Galdakao-modified supine Valdivia position. The tilt of the major renal axis was significantly greater in the prone position than the corresponding values in the oblique position (19.4° vs 8.5°; P = 0.019). CONCLUSIONS Anatomical variation might result in the differences of renal puncture calyx. Endoscopic combined intrarenal surgery in the Galdakao-modified supine Valdivia position may bring equal stone-free status, with a longer surgical time but fewer complications including febrile urinary tract infection and urinary tract injury than the prone split-leg position.
Collapse
Affiliation(s)
- Shuzo Hamamoto
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shinsuke Okada
- Department of Urology, Gyotoku General Hospital, Chiba, Japan
| | - Takaaki Inoue
- Department of Urology, Hara Genitourinary Hospital, Hyogo, Japan
| | - Kazumi Taguchi
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kengo Kawase
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tomoki Okada
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryosuke Chaya
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tatsuya Hattori
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Atsushi Okada
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | |
Collapse
|
26
|
Falahatkar R, Shahraki T, Falahatkar S, Esmaeili S, Mashouf P. Evaluating outcomes of complete supine percutaneous nephrolithotomy for staghorn vs multiple non-staghorn renal stones: a 10-year study. World J Urol 2021; 39:3071-3077. [PMID: 33403437 DOI: 10.1007/s00345-020-03563-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To evaluate the outcomes of complete supine percutaneous nephrolithotomy (csPCNL) for staghorn stones and multiple large non-staghorn stones. METHODS The records of 886 patients who underwent csPCNL from September 2009 to October 2019 were considered. Out of them, 201 cases met the eligibility criteria and they were divided into three groups: 63 cases of staghorn, 68 cases of multiple medium (20 mm < diameter ≤ 30 mm) non-staghorn and 70 cases of multiple large non-staghorn (> 30 mm) stones. Almost all outcomes and stone-related factors were analyzed. RESULTS There was not any significant difference regarding age, body mass index, history of urinary tract infection, transfusion rate, complication rate, pre and post-surgery serum creatinine, hemoglobin drop and total hospital stay between the three groups. Stone free rate was 98.5% in multiple medium group, 97.1% in multiple large group and 84.1% in staghorn group (P = 0.001). The operation duration was significantly shorter for the multiple medium group (P < 0.001) but it was not significantly different between the multiple large non-staghorn and staghorn group. CONCLUSION The results demonstrated that almost all outcomes were not significantly different between the three groups (especially between staghorn and larger non-staghorn ones). These findings reveal that surgeons could choose csPCNL for treatment of staghorn stones and multiple large non-staghorn stones and consider staghorn stones as challenging as multiple large (especially diameter > 30 mm) non-staghorn stones.
Collapse
Affiliation(s)
- Reza Falahatkar
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Tamkin Shahraki
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Siavash Falahatkar
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Samaneh Esmaeili
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Parham Mashouf
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
27
|
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.
Collapse
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
| |
Collapse
|
28
|
Falahatkar S, Esmaeili S, Rastjou Herfeh N, Kazemnezhad E, Falahatkar R, Yeganeh M, Jafari A. The safety of continued low dose aspirin therapy during Complete Supine Percutaneous Nephrolithotomy (csPCNL). Prog Urol 2021; 32:458-464. [PMID: 34154964 DOI: 10.1016/j.purol.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 02/24/2021] [Accepted: 04/02/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Using anticoagulants and antiplatelet drugs in patients with cardiovascular and medical comorbidities is prevalent. Because of hyper vascular nature of kidney, physicians tend to stop using aspirin before percutaneous nephrolithotomy (PCNL). We have shown the effects of remaining on low dose aspirin in complete supine PCNL (csPCNL). MATERIAL AND METHODS The records of 643 patients who underwent csPCNL between 2012 and 2018 were analyzed. Surgical outcomes and complications of patients who were on aspirin therapy and continued it daily (group A) were compared with those not taking aspirin (group B). RESULTS Of the 643 csPCNLs, 40 (6%) were performed in patients of group A and the rest of 603 (94%) cases were in group B. The differences between the mean age of groups were statistically significant (60.08±9.45, group A and 48.66±12.32, group B) (P<0.001). Thirty-nine (97.5%) of patients in group A and 548 (90.9%) of group B were stone free by the end of the study which was not statistically significant (P=0.118). The mean operative time between groups A and B (43.20±21.37 and 44.83±16.83, respectively) was not considered significant (P=0.561). There was also no significant difference between 2 groups in any types of complications. Multivariate analysis showed that, perioperative aspirin use was not a significant predictor of transfusion, Hb drop, operative time and other complications. CONCLUSIONS Remaining on aspirin does not increase the risk of bleeding, transfusionand other complications. Consequently, continuing aspirin prioperatively in csPCNL appears safe. There is no fear for continuing aspirin in csPCNL. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- S Falahatkar
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - S Esmaeili
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - N Rastjou Herfeh
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - E Kazemnezhad
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - R Falahatkar
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - M Yeganeh
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - A Jafari
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| |
Collapse
|
29
|
Yue G, Lei Y, Karagöz MA, Zhu H, Cheng D, Cai C, Wu X, Li Z, Zhao Y, Liu Y. Comparison of the Prone Split-Leg Position with the Traditional Prone Position in Percutaneous Nephrolithotomy: A Propensity Score-Matching Study. J Endourol 2021; 35:1333-1339. [PMID: 33813867 DOI: 10.1089/end.2020.0791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background and Objective: Several positions have been described for percutaneous nephrolithotomy (PCNL). The aim of this study was to compare the safety and effectiveness of the traditional prone position PCNL (TP-PCNL) and the prone split-leg position PCNL (PSL-PCNL). Patients and Methods: A retrospective review was made of the data of 212 patients who underwent prone PCNL in PSL or TP between January 2017 and November 2019. The demographic and preoperative clinical data were used for propensity score-matching (PSM). Following the PSM based on a multivariable logistic regression model, the PSL-PCNL and TP-PCNL groups were compared in preoperative, perioperative, and postoperative parameters. All surgical procedures were performed by an experienced endourologist. Results: After PSM, 51 patients from the PSL-PCNL group were matched to 51 TP-PCNL patients. The stone burden was not statistically significant between the two groups (p = 0.388). The mean operation time of the two groups was significantly different (81.5 ± 32.4 minutes vs 93.1 ± 25.9 minutes, respectively, p = 0.026). The hemoglobin decrease in the PSL-PCNL group was greater than that in the TP-PCNL group (-17.7 ± 16.9 g/L vs 13.1 ± 10.9 g/L, p < 0.001). Both groups had similar stone-free rates after 2 weeks (p = 0.49). No significant difference was observed between the groups in the total complication rate (p = 1). Conclusions: The application of PSL in PCNL simplifies the surgical procedure and shortens the operating time. Another important advantage is that it allows retrograde intrarenal surgery and ureteroscopy to be performed simultaneously. We recommend the PSL to be applied in PCNL for renal stone patients.
Collapse
Affiliation(s)
- Gaoyuanzhi Yue
- Department of Urology and Guangdong Key Laboratory of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yeci Lei
- Department of Urology and Guangdong Key Laboratory of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Mehmet Ali Karagöz
- Department of Urology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Huacai Zhu
- Department of Urology and Guangdong Key Laboratory of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Donglong Cheng
- Department of Urology and Guangdong Key Laboratory of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chao Cai
- Department of Urology and Guangdong Key Laboratory of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiangkun Wu
- Department of Urology and Guangdong Key Laboratory of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhilin Li
- Department of Urology and Guangdong Key Laboratory of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yan Zhao
- Department of Urology and Guangdong Key Laboratory of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yongda Liu
- Department of Urology and Guangdong Key Laboratory of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
30
|
Jiang Y, Zhang J, Kang N, Niu Y, Li Z, Yu C, Zhang J. Current Trends in Percutaneous Nephrolithotomy in China: A Spot Survey. Risk Manag Healthc Policy 2021; 14:2507-2515. [PMID: 34163270 PMCID: PMC8216069 DOI: 10.2147/rmhp.s301484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/02/2021] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To describe trends in the procedure of percutaneous nephrolithotomy (PCNL) in China to identify training needs. METHODS A spot survey with 36 questions, which revealed demographic data, patterns of PCNL practice, and opinions regarding specific clinical cases, was administered to Chinese urologists during the 17th National Urological Urolithiasis Symposium held in Dandong in 2018. RESULTS Out of 400 participants, 221 responses to the survey were received. PCNL was performed by 80.5% of the participants, and 70.2% of them were senior clinicians. It was found that 91% used the prone decubitus in training programs and 27.6% the modified supine, and 46.6% were apprenticeship trained for PCNL, while 5.6% trained during their residency. The prone position was the preferred decubitus, even for obese patients. All of the urologists established their own access, 93.7% used ultrasonography guidance alone, 70.7% used ultrasonic and/or pneumatic lithotripters, and 29.2% used laser. When exiting the kidney, 73.8% placed a nephrostomy tube whereas 26.2% used the tubeless technique. For postoperative follow-up, 51.3% used computed tomography (CT) or ultrasonography plus kidney-ureter-bladder (KUB) to monitor the results of procedures, while 45% used KUB alone. Colonic injury was reported by 8.9%. Average hospital stays of >3 days were reported for 81.2% of procedures. CONCLUSION Chinese urologists obtain their own access during PCNL, with ultrasonic guidance in most cases, and almost a half of them are apprenticeship trained. They prefer the prone position, use fascial dilators, and place a nephrostomy tube when exiting the kidney. Most urologists follow the official management guidelines in special cases. Skilled use of urological ultrasound examination, flexible nephroscopy, postoperative CT, tubeless procedures in selected patients, and urology residency training are recommended for PCNL practice.
Collapse
Affiliation(s)
- Yuguang Jiang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, The People’s Republic of China
| | - Jiqing Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, The People’s Republic of China
| | - Ning Kang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, The People’s Republic of China
| | - Yinong Niu
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, The People’s Republic of China
| | - Zhiwen Li
- Institute of Reproductive and Child Health, Peking University, School of Public Health, Peking University, Beijing, 100191, The People’s Republic of China
| | - Changlian Yu
- Department of Urology, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, 014010, The People’s Republic of China
| | - Junhui Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, The People’s Republic of China
| |
Collapse
|
31
|
Soliman T, Khalil M, Omar R, Mohey A, Ahmed S, Sherif H, Abdelazim M. Management of upper calyceal stone by percutaneous nephrolithotomy through lower calyx access: prone versus supine position. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00025-w] [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
The best way in the management of calyceal stone by percutaneous nephrolithotomy (PCNL) is to go directly into the desired calyx. However, in upper calyx, this direct entry may be associated with undesired complications, and through lower calyx is limited in prone PCNL. Recently, there is another option about reaching it through the lower calyx in supine position with more accessibility and better manipulation. This study aimed to evaluate the management of the upper calyceal stone by PCNL through lower calyx access in prone versus supine position.
Methods
A total of 38 patients with upper calyceal stone (≥ 2 cm) were randomly divided into two groups; the first group included 18 patients managed by PCNL in the prone position, and the second group included 20 patients managed in supine position. All data of both procedures were collected and statistically analyzed to compare between both groups.
Results
There is no statistically significant difference between groups as regards demographic and stone characters. The angle between the access to the lower calyx and access of the upper calyx was significantly wider in the supine group versus prone group (130.2° ± 23.46° vs. 89.67° ± 14.56°, respectively). The mean operative and fluoroscopy time was significantly longer in the prone group. There is no significant difference in intraoperative or postoperative morbidity. The stone-free rate was significantly higher in the supine group than the prone group (85% vs 38.9%, respectively). Also stone approachability was higher in the supine group than prone group (95% vs. 66.7%, respectively).
Conclusion
Management of upper calyceal stone by PCNL through the lower calyx is safe, but it is more effective in the supine position than in prone position.
Collapse
|
32
|
Kim BS. Surgical management of urinary stone. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.11.677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Urolithiasis is a common urological disease that causes a significant deterioration in patients’ life quality due to severe pain and frequent recurrence. With increases in the incidence of urolithiasis, different treatment methods have been developed. Although urolithiasis is still managed in Korea with extracorporeal shock wave lithotripsy, the development of minimally invasive techniques and endoscopy instruments has led to increased surgery. Prior to the introduction of endoscopy, urolithiasis surgery was performed as open procedures such as ureterolithotomy, pyelolithotomy, and nephrolithotomy. However, most recent stone surgeries are performed using endoscopy with comparable outcomes and fewer complications. Laparoscopic or robot-assisted laparoscopic surgeries are performed in exceptional cases. Since urolithiasis can be found in various urinary organs, such as the kidney, ureter, bladder, and even the urethra, the approach, method, and availability of endoscopy will vary depending on the stoneʼs size and location. Understanding the types and characteristics of each surgical method will determine the appropriate procedure for each patient and improve the surgical outcomes.
Collapse
|
33
|
Lo KL, Leung D, Li JK, Mak SK, Wong HM, Ng CF. Simultaneous transurethral bipolar enucleation of the prostate, supine ultrasound-guided percutaneous nephrolithotomy and open cystolithotomy: A feasible and safe approach. Urol Case Rep 2020; 33:101364. [PMID: 33102063 PMCID: PMC7573940 DOI: 10.1016/j.eucr.2020.101364] [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: 07/21/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/22/2022] Open
Abstract
Management of the coexisting hard renal pelvic stone, large urinary bladder stone and benign prostatic hyperplasia is not common which can be difficult. Here we reported a case of a 70-year-old Asian male who presented with 1.5cm renal pelvic stone, 5cm large bladder stone and 96 cc benign enlarged prostate, which were managed by simultaneous transurethral bipolar enucleation of the prostate (BipoLEP), supine ultrasound-guided percutaneous nephrolithotomy (PCNL) and open cystolithotomy. Simultaneous transurethral BipoLEP, supine ultrasound-guided PCNL and open cystolithotomy are feasible and safe, with the advantage of minimizing the patient's operation and anesthesia time.
Collapse
Affiliation(s)
- Ka Lun Lo
- Division of Urology, North District Hospital, New Territories East Cluster Urology Unit, Prince of Wales Hospital, Shatin, Hong Kong, China
- Corresponding author.
| | - David Leung
- Division of Urology, North District Hospital, New Territories East Cluster Urology Unit, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Joseph K.M. Li
- Division of Urology, North District Hospital, New Territories East Cluster Urology Unit, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Siu King Mak
- Division of Urology, North District Hospital, New Territories East Cluster Urology Unit, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Hon Ming Wong
- Division of Urology, North District Hospital, New Territories East Cluster Urology Unit, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Chi Fai Ng
- Division of Urology, North District Hospital, New Territories East Cluster Urology Unit, Prince of Wales Hospital, Shatin, Hong Kong, China
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, China
| |
Collapse
|
34
|
Keller EX, DE Coninck V, Proietti S, Talso M, Emiliani E, Ploumidis A, Mantica G, Somani B, Traxer O, Scarpa RM, Esperto F. Prone versus supine percutaneous nephrolithotomy: a systematic review and meta-analysis of current literature. Minerva Urol Nephrol 2020; 73:50-58. [PMID: 33016031 DOI: 10.23736/s2724-6051.20.03960-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Percutaneous nephrolithotomy (PNL) can be performed either in prone or supine position. This study aimed at gathering together randomized controlled trials (RCTs) comparing efficacy and safety between prone and supine PNL. EVIDENCE ACQUISITION Systematic review of literature was conducted using the Scopus, Medline and Web of Science databases. Study selection, data extraction and quality assessment were independently assessed by two authors. Meta-analysis was performed with Review Manager 5.3. Sensitivity analyses were performed to exclude studies with high risk of bias. EVIDENCE SYNTHESIS Pooled data from 12 studies including 1290 patients were available for analysis. Only one study was found to have overall low risk of bias. Significantly shorter operative time was found in favor of supine PNL (mean difference 13 minutes, 95% confidence interval [CI]: 3.4-22.7; P<0.01). Stone-free rate (SFR)≥14 days after surgery was significantly higher in prone PNL (odds ratio [OR]=2.15, 95% CI: 1.07-4.34; P=0.03). Significantly higher fever rate was found in prone PNL (OR=1.60, 95% CI: 1.03-2.47; P=0.04). Overall SFR, hospital stay length, complications rate, transfusions rate and blood loss, as well as non-lower calyx puncture rate, puncture attempts and tubeless intervention rate did not differ between prone and supine PNL (P>0.05). CONCLUSIONS Efficacy of PNL seems balanced between prone and supine position, with comparable overall SFR and shorter operative time in favor of supine PNL. Safety of PNL appears in favor of supine PNL, with lower fever rate. Because of study heterogeneity and possible risks of outcome bias, results from this study should be interpreted with caution. Altogether, both prone and supine PNL account for appropriate therapy options.
Collapse
Affiliation(s)
- Etienne X Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland -
| | | | - Silvia Proietti
- Department of Urology, Ville Turro Division, European Training Center for Endourology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Michele Talso
- Department of Urology, Hospital of Vimercate, Vimercate, Monza-Brianza, Italy
| | - Esteban Emiliani
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Guglielmo Mantica
- Department of Urology, IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy
| | - Bhaskar Somani
- University Hospital Southampton NHS Trust, University of Southampton, Southampton, UK
| | - Olivier Traxer
- Department of Urology, Sorbonne University, GRC N. 20 Lithiase Urinaire, Hospital Tenon AP-HP, Paris, France
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | | | | |
Collapse
|
35
|
Ferreira TAC, Dutra MMG, Vicentini FC, Szwarc M, Mota PKV, Eisner B, Murta CB, Claro JFDA. Impact of Obesity on Outcomes of Supine Percutaneous Nephrolithotomy. J Endourol 2020; 34:1219-1222. [PMID: 32539465 DOI: 10.1089/end.2020.0576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objectives: To determine whether obesity has an impact on the outcomes of supine percutaneous nephrolithotomy (PCNL). Patients and Methods: We retrospectively evaluated a prospectively created database of patients who underwent PCNL in the supine position from June 2009 to June 2014. The patients were divided into two groups according to their body mass index (BMI): <30 kg/m2 (group 1, nonobese) and ≥30 kg/m2 (group 2, obese). Pre, peri, and postoperative data were analyzed. Stone complexity was classified according to Guy's stone score. The primary endpoint was the absence of stone fragments of ≥4 mm on CT scans at postoperative day 1. Complications were graded according to the modified Clavien classification. Results: Of the 401 patients, 307 (76.6%) were nonobese and 94 (23.4%) were obese. Regarding demographic and stone characteristics, group 2 (BMI ≥30 kg/m2) had a higher percentage of female patients (67.3% vs 50.4%, p = 0.002) and a higher mean BMI (34.8 vs 24.5 kg/m2, p < 0.001) than group 1. Success rates were not statistically different between the groups (group 1 = 61.8%, group 2 = 51%, p = 0.08). There were no differences in the transfusion rate (group 1 = 2.9%, group 2 = 4.2%, p = NS) or total number of complications greater than Clavien grade 1 (group 1 = 13.6%, group 2 = 13.8%, p = NS). Conclusion: In a retrospective study of 400 patients undergoing PCNL, the outcomes were not different between nonobese and obese patients. To our knowledge, this is the first study evaluating these outcomes for PCNL performed in the supine position. Further multicenter and prospective studies are necessary to verify these findings.
Collapse
Affiliation(s)
| | | | - Fabio Carvalho Vicentini
- Departamento de Urologia, Setor de Endourologia e Litíase, Hospital Brigadeiro, São Paulo, São Paulo, Brasil
| | - Marcelo Szwarc
- Departamento de Urologia, Setor de Endourologia e Litíase, Hospital Brigadeiro, São Paulo, São Paulo, Brasil
| | - Priscila Kuriki Vieira Mota
- Departamento de Urologia, Setor de Endourologia e Litíase, Hospital Brigadeiro, São Paulo, São Paulo, Brasil
| | - Brian Eisner
- Departament of Urology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Claudio Bovolenta Murta
- Departamento de Urologia, Setor de Endourologia e Litíase, Hospital Brigadeiro, São Paulo, São Paulo, Brasil
| | | |
Collapse
|
36
|
[Clinical outcomes of simultaneous bilateral endoscopic surgery for bilateral upper urinary tract calculi]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2020. [PMID: 32773799 PMCID: PMC7433631 DOI: 10.19723/j.issn.1671-167x.2020.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To discuss the efficacy and safety of simultaneous bilateral endoscopic surgery (SBES) for bilateral upper urinary tract calculi, and to summarize the initial experience. METHODS Patients diagnosed with bilateral upper urinary tract calculi who underwent SBES in the Department of Urology, Beijing Chao-Yang Hospital from January 2019 to January 2020 were enrolled retrospectively. The demographic and clinical data of the patients were recorded, and the operation status, stone free rate (SFR) and peri-operative complications were analyzed. The primary end point was SFR, and second end point was peri-operative complications. RESULTS A total of 23 patients underwent SBES, of which SBES was completed in 19 patients (12 males, and 7 females). The mean age was (41.3±12.0) years. Fourteen patients underwent modified supine position surgery and 4 patients in prone split-leg position. There was no statistical difference in the demographic and baseline clinical data of the patients in different positions. One patient underwent right percutaneous nephrolithotomy (PCNL) and left endoscopic combined intra-renal surgery (ECIRS) in the prone split-leg position, while 18 patients received simul-taneous surgery with PCNL and contralateral retrograde intra-renal surgery (RIRS). The mean anesthesia and operation time was (128.7±26.5) min and (70.7±20.3) min, respectively, which was significantly longer in the patients with prone split-leg position than in the patients with modified supine position, anesthesia time in the patients with prone split-leg position and modified supine position: (148.4±20.4) min vs. (121.6±25.3) min, respectively, t=-2.121, P=0.049, while the operation time in the patients with prone split-leg position and modified supine position: (86.4±21.1) min vs. (65.1±17.4) min, respectively, t=-2.222, P=0.040. There was no significant difference between the two groups in indwelling of nephrostomy [prone split-leg position and modified supine position: (2.6±0.9) d vs. (2.1±1.0) d, respectively; t=-0.880, P=0.391] and the length of hospital stay [prone split-leg position and modified supine position: (6.0±2.7) d vs. (5.2±1.8) d, respectively; t=-0.731, P=0.475]. One month after the operation, the SFR was 78.9%, and 3 patients had minor peri-operative complications (Clavien-Dindo grades Ⅰ/Ⅱ) without any serious complications (Clavien-Dindo grades Ⅲ/Ⅳ/Ⅴ). CONCLUSION The simultaneous bilateral endoscopic surgery would decrease the operation time and anesthesia exposure under the premise of ensuring the SFR, which is helpful to reduce the risk of peri-operative complications, especially to the patients who can not tolerate the second-stage or long-time operation.
Collapse
|
37
|
Klein I, Gutiérrez-Aceves J. Preoperative imaging in staghorn calculi, planning and decision making in management of staghorn calculi. Asian J Urol 2020; 7:87-93. [PMID: 32257800 PMCID: PMC7096669 DOI: 10.1016/j.ajur.2019.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/25/2019] [Accepted: 05/20/2019] [Indexed: 11/19/2022] Open
Abstract
Objective Staghorn calculi present a particular and challenging entity of stone morphology. Treatment is associated with lower stone-free rates and higher complication rates compared to non-staghorn stones. In this review we looked for the most relevant data on preoperative imaging and access planning to help decision making for percutaneous surgery with this complex condition. Methods We conducted a PubMed search of publications in the past 2 decades that include relevant information on the planning for management of staghorn stones. Non-contrast computerized tomography (NCCT) is indeed the standard imaging tool for percutaneous nephrolithotomy (PCNL); additional tools such as three-dimensional computed tomography (CT) reconstruction of the staghorn calculus may help plan access in complex cases. Ultrasound guided percutaneous access may be considered for staghorn stones when planning upper pole access in kidney malposition or complex intrarenal anatomy or with complex body habitus. Wideband doppler ultrasound and real-time virtual sonography can assist. New technologies to improve kidney access such as Uro Dyna-CT or electromagnetic sensor have been reported, but have not shown utilization in staghorn cases. Staghorn morphometry-based prediction algorithms may predict the number of tract(s) and stage(s) for PCNL monotherapy. Lower pole access can be equally effective as upper pole when planning for staghorn and complex stones, with significantly less complications rate; Stone-Tract length-Obstruction-Number of involved calyces-Essence of stone density (STONE) nephrolithometry seems to be the best system to predict outcomes of PCNL in staghorn cases. There is a growing trend of endoscopic combined intrarenal surgery (ECIRS) in concordance with PCNL to treat larger stones. Conservative management of staghorn calculi is an undesired option, but can be an alternative for a carefully selected group of high-risk patients. Conclusion Staghorn stones may lead to deterioration of renal function and life-threatening urosepsis. This entity should be managed aggressively with planning ahead for surgery using the different tools available as the cornerstone for a successful outcome.
Collapse
|
38
|
Birowo P, Tendi W, Widyahening IS, Rasyid N, Atmoko W. Supine versus prone position in percutaneous nephrolithotomy: a systematic review and meta-analysis. F1000Res 2020; 9:231. [PMID: 33014345 PMCID: PMC7509599 DOI: 10.12688/f1000research.22940.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2020] [Indexed: 08/15/2023] Open
Abstract
Background: The decision for using supine or prone position in percutaneous nephrolithotomy (PCNL) is still debatable. The aim of this study is to compare the efficacy and safety profile of the supine and prone position when performing PCNL. Methods: A systematic electronic search was performed using the database from MEDLINE, Cochrane library and Google Scholar from January 2009 to November 2019. The outcomes assessed were stone free rate, major complication rate, length of hospital stay and mean operation time. Results: A total of 11 articles were included in qualitative and quantitative analysis. The efficacy of PCNL in supine position as determined by stone free rate is significantly lower than in prone position (OR: 0.74; 95% CI: 0.66 - 0.83; p<0.00001), However, major complication rate is also lower in the supine group compared with the prone group (OR: 0.70; 95% CI: 0.51 - 0.96; p=0.03). There is no statistically significant difference in the length of hospital stay and mean operation time between both groups. Conclusion: Prone position leads to a higher stone free rate, but also a higher rate of major complication. Thus, the decision of using which position during PCNL should be based on the surgeon's experience and clinical aspects of the patients.
Collapse
Affiliation(s)
- Ponco Birowo
- Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - William Tendi
- Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Indah S. Widyahening
- Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Nur Rasyid
- Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Widi Atmoko
- Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| |
Collapse
|
39
|
Birowo P, Tendi W, Widyahening IS, Rasyid N, Atmoko W. Supine versus prone position in percutaneous nephrolithotomy: a systematic review and meta-analysis. F1000Res 2020; 9:231. [PMID: 33014345 PMCID: PMC7509599.2 DOI: 10.12688/f1000research.22940.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2020] [Indexed: 03/30/2024] Open
Abstract
Background: The decision for using supine or prone position in percutaneous nephrolithotomy (PCNL) is still debatable. The aim of this study is to compare the efficacy and safety profile of the supine and prone position when performing PCNL. Methods: A systematic electronic search was performed using the database from MEDLINE, Cochrane library and Google Scholar from January 2009 to November 2019. The outcomes assessed were stone free rate, major complication rate, length of hospital stay and mean operation time. Results: A total of 11 articles were included in qualitative and quantitative analysis. The efficacy of PCNL in supine position as determined by stone free rate is significantly lower than in prone position (OR: 0.74; 95% CI: 0.66 - 0.83; p<0.00001), However, major complication rate is also lower in the supine group compared with the prone group (OR: 0.70; 95% CI: 0.51 - 0.96; p=0.03). There is no statistically significant difference in the length of hospital stay and mean operation time between both groups. Conclusion: Prone position leads to a higher stone free rate, but also a higher rate of major complication. Thus, the decision of using which position during PCNL should be based on the surgeon's experience and clinical aspects of the patients.
Collapse
Affiliation(s)
- Ponco Birowo
- Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - William Tendi
- Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Indah S Widyahening
- Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Nur Rasyid
- Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Widi Atmoko
- Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| |
Collapse
|
40
|
Birowo P, Tendi W, Widyahening IS, Rasyid N, Atmoko W. Supine versus prone position in percutaneous nephrolithotomy: a systematic review and meta-analysis. F1000Res 2020; 9:231. [PMID: 33014345 PMCID: PMC7509599 DOI: 10.12688/f1000research.22940.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 11/23/2022] Open
Abstract
Background: The decision for using supine or prone position in percutaneous nephrolithotomy (PCNL) is still debatable. The aim of this study is to compare the efficacy and safety profile of the supine and prone position when performing PCNL. Methods: A systematic electronic search was performed using the database from MEDLINE, Cochrane library and Google Scholar from January 2009 to November 2019. The outcomes assessed were stone free rate, major complication rate, length of hospital stay and mean operation time. Results: A total of 11 articles were included in qualitative and quantitative analysis. The efficacy of PCNL in supine position as determined by stone free rate is significantly lower than in prone position (OR: 0.74; 95% CI: 0.66 - 0.83; p<0.00001), However, major complication rate is also lower in the supine group compared with the prone group (OR: 0.70; 95% CI: 0.51 - 0.96; p=0.03). There is no statistically significant difference in the length of hospital stay and mean operation time between both groups. Conclusion: Prone position leads to a higher stone free rate, but also a higher rate of major complication. Thus, the decision of using which position during PCNL should be based on the surgeon's experience and clinical aspects of the patients.
Collapse
Affiliation(s)
- Ponco Birowo
- Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - William Tendi
- Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Indah S Widyahening
- Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Nur Rasyid
- Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Widi Atmoko
- Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| |
Collapse
|
41
|
Taguchi K, Hamamoto S, Okada A, Tanaka Y, Sugino T, Unno R, Kato T, Ando R, Tan YK, Yasui T. Robot-Assisted Fluoroscopy Versus Ultrasound-Guided Renal Access for Nephrolithotomy: A Phantom Model Benchtop Study. J Endourol 2019; 33:987-994. [DOI: 10.1089/end.2019.0432] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Kazumi Taguchi
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shuzo Hamamoto
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Atsushi Okada
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yutaro Tanaka
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Teruaki Sugino
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Rei Unno
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Taiki Kato
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryosuke Ando
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yung-Khan Tan
- Urohealth Medical Clinic, Mt. Elizabeth Hospital, Novena, Singapore
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| |
Collapse
|
42
|
Burns H, Nalagatla S. The risk factors associated with colonic injury during percutaneous renal stone surgery – a literature review. JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415819837442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: A focused literature review was conducted of colonic injuries occurring during percutaneous nephrolithotomy (PCNL) procedures to determine the importance of patient position, identifiable risk factors and methods to avoid colonic injury. Method: A MEDLINE literature search was performed from PubMed and Scopus databases to retrieve all articles relating to colonic injuries occurring during PCNL. Incidence of colonic injury, patient management, position, side of stone and recognised risk factors were compiled for analysis. Results: Of the 35,054 PCNLs carried out, 87 colonic perforations were identified, which results in a 0.25% chance of perforation. A total of 65.5% (57/87) of colonic perforations occurred during left-hand punctures, and 54.0% (47/87) occurred in the prone position. Retrorenal colon, posterior colon, previous renal tract surgery, horseshoe kidney and mobile kidneys were the most common risk factors identified. Discussion: The risk of colonic perforation during PCNL was 0.25% across these studies. It more commonly occurred in the prone position and on the left-hand side. Only four perforations were noted to be in the supine position. A retrorenal colon is implicated as the most common identifiable risk factor. Careful preoperative work-up, planning and intraoperative use of ultrasound combined with fluoroscopy is the best method of preventing a colonic injury. Level of evidence: Not applicable for this multicentre audit.
Collapse
Affiliation(s)
- H Burns
- Urology, University Hospital Monklands, UK
| | | |
Collapse
|
43
|
Gökce Mİ, Gülpınar Ö, Akpınar Ç, Tangal S, Süer E, Göğüş Ç, Yaman Ö. Description of a novel method for renal puncture in supine percutaneous nephrolithotomy and comparison with a previously described method. Turk J Urol 2019; 45:444-448. [PMID: 31603419 DOI: 10.5152/tud.2019.33958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/29/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The supine position is becoming increasingly popular in percutaneous nephrolithotomy (PNL). Renal puncture is the key step for a successful PNL procedure. The aim of this study was to describe a novel method for renal puncture and compare it with a previously described method. MATERIAL AND METHODS Data of 358 patients who underwent PNL in the supine position were collected prospectively. In 165 patients, the puncture was performed by a previously described method (Group 1), and in 193 patients, the puncture was performed with the novel method (Group 2). Groups were compared with regard to total time and fluoroscopy time to successful puncture. In the novel puncture technique, the needle is advanced toward the targeted calyx under monoplane fluoroscopy. To determine the needle depth, the C-arm is rotated by 10°. If the needle projection is beyond the targeted calyx in fluoroscopy, the puncture is deeper than desired. If the needle projection does not reach the targeted calyx, the puncture is more superficial than desired. RESULTS Groups were similar with regard to the mean age, gender distribution, body mass index, stone size, and site of puncture. The mean total time to puncture was 88.2±25.3 seconds in Group 1 and 54.3±22.3 seconds in Group 2, and the difference was statistically significant (p=0.03). The mean fluoroscopy time to puncture was 16.1±5.3 seconds in Group 1 and 9.3±3.4 seconds in Group 2, and the difference was statistically significant (p=0.03). CONCLUSION This novel method to determine the depth of the needle is simple, reproducible, and has the potential to diminish radiation exposure with the aid of intermittent fluoroscopy.
Collapse
Affiliation(s)
- Mehmet İlker Gökce
- Department of Urology, Ankara University School of Medicine Ankara, Turkey
| | - Ömer Gülpınar
- Department of Urology, Ankara University School of Medicine Ankara, Turkey
| | - Çağrı Akpınar
- Department of Urology, Ankara University School of Medicine Ankara, Turkey
| | - Semih Tangal
- Department of Urology, Ufuk University School of Medicine Ankara, Turkey
| | - Evren Süer
- Department of Urology, Ankara University School of Medicine Ankara, Turkey
| | - Çağatay Göğüş
- Department of Urology, Ankara University School of Medicine Ankara, Turkey
| | - Önder Yaman
- Department of Urology, Ankara University School of Medicine Ankara, Turkey
| |
Collapse
|
44
|
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: 8] [Impact Index Per Article: 1.6] [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.
Collapse
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
| |
Collapse
|
45
|
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: 10] [Impact Index Per Article: 2.0] [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.
Collapse
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
| | | |
Collapse
|
46
|
Supine versus prone position for percutaneous nephrolithotripsy: A meta-analysis of randomized controlled trials. Int J Surg 2019; 66:62-71. [PMID: 31034987 DOI: 10.1016/j.ijsu.2019.04.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/11/2019] [Accepted: 04/23/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To compare the safety and efficacy of percutaneous nephrolithotripsy (PCNL) in supine versus prone position for patients with renal or upper ureteral calculi. METHODS A systematic search of Pubmed, Embase and Cochrane Central Register of Controlled Trials was performed to identify all eligible studies. All included randomized controlled trials (RCTs) were evaluated based on the inclusion and exclusion criteria. After quality assessment and date extraction, a meta-analysis was performed using RevMan 5.3 software. RESULTS A total of 15 RCTs with 1474 patients were included in our meta-analysis. Pooled data showed that PCNL in supine position could significantly reduce the operative time [weighted mean difference (WMD) -12.02, 95% confidence interval (CI) -20.49 to -3.54, p = 0.005] and rate of fever [risk ratio (RR) 0.67, 95% CI 0.46 to 0.97, p = 0.03] compared to prone position. In addition, no significant differences could be found between groups in stone-free rate (p = 0.31), hospital stay (p = 0.59) and rate of overall complications (p = 0.11), mainly including urinary leakage (p = 0.83), pleural effusion (p = 0.74) and blood transfusion (p = 0.58). CONCLUSIONS The current study found comparable stone-free rate and significant lower rate of postoperative fever in supine PCNL compared with prone PCNL. PCNL in supine position could be a safe and efficient choice for patients with renal or upper ureteral calculi.
Collapse
|
47
|
Altschuler J, Jain R, Ganesan V, Monga M. Supracostal Upper Pole Endoscopic-Guided Prone Tubeless “Maxi-Percutaneous Nephrolithotomy”: A Contemporary Evaluation of Complications. J Endourol 2019; 33:274-278. [DOI: 10.1089/end.2018.0502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Joshua Altschuler
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Rajat Jain
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Vishnu Ganesan
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Manoj Monga
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| |
Collapse
|
48
|
Complete Ultrasound-guided Percutaneous Nephrolithotomy in Prone and Supine Positions: A Randomized Controlled Study. Urology 2019; 128:31-37. [PMID: 30902696 DOI: 10.1016/j.urology.2019.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To evaluate the safety, efficacy, adverse events, and feasibility of ultrasound guided percutaneous nephrolithotomy (US-PCNL) in the management of large renal stones in supine and prone positions and to point out the practical considerations related to these techniques in comparison with standard PCNL. PATIENTS AND METHODS This study was conducted between August 2013 to September 2018 as a prospective randomized and controlled study. A total of 392 consecutive patients with nephrolithiasis >2 cm were randomly assigned to undergo ultrasound PCNL in prone (P-US-PCNL) (132 patients); supine position (S-US-PCNL) (129 patients) or conventional PCNL (C-PCNL) (131 patients). The preoperative parameters, the intraoperative findings, operative time, hospital stay, perioperative morbidities, stone free rate, and related data were recorded. RESULTS The demographic and the baseline characteristics were comparable in all study groups. The mean number of trails and time for successful puncture in P-US-PCNL, S-US-PCNL, and C-PCNL were 1.9 ± 1, 2.3 ± 1.2, and 1.7±1, respectively (P < .001), and 15.8 ± 5.8, 19.3 ± 9.4, and 16.5 ± 8.1 seconds, respectively (P < .001). The operation time was 69 ± 22, 75 ± 23, and 72 ± 27 minutes, respectively, (P > .05). The mean nephrostomy time and length of hospital stay were 3 ± 1.3, 3.4 ± 1.5, 3.2 ± 1.2 hours, respectively, and 3.8 ± 1.5, 4.1 ± 1.5, 3.9 ± 1.3 days, respectively (P > .05). The mean percentage decrease in hemoglobin concentration was 1.65 ± 0.66, 1.77 ± 0.78, and 2.1 ± 0.9, respectively (P < .001), overall stone clearance was 88%, 79%, and 85%, respectively (P > .05). Complications were acceptable and similar between groups. CONCLUSION US-PCNL either in prone or supine position is as effective, feasible, and safe as C-PCNL with zero radiation exposure.
Collapse
|
49
|
Li JK, Teoh JY, Ng CF. Updates in endourological management of urolithiasis. Int J Urol 2018; 26:172-183. [PMID: 30575154 DOI: 10.1111/iju.13885] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/21/2018] [Indexed: 12/23/2022]
Abstract
Urinary stone disease, or urolithiasis, is a very common disease with increasing prevalence and incidence. With the advancement of endoscopic techniques, the treatment outcomes of ureteroscopy (or transureteral lithotripsy) and percutaneous nephrolithotomy are continuously improving. In recent years, there have been many new developments in the field, including new endoscopy design, more effective auxiliary tools, improvement in treatment protocols, introduction of robotic technology, combining both ureteroscopy and percutaneous nephrolithotomy (endoscopic combined intrarenal surgery or transureteral lithotripsy-assisted percutaneous nephrolithotomy), improvement in laser technology, and so on. All these new inputs will further improve the treatment efficacy and safety of the procedures, thus benefiting our patients. In the present review, we briefly go through the main steps of ureteroscopy and percutaneous nephrolithotomy, with a concise description and application of these new advances.
Collapse
Affiliation(s)
- Joseph Km Li
- S. H. Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jeremy Yc Teoh
- S. H. Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chi-Fai Ng
- S. H. Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| |
Collapse
|
50
|
Mourmouris P, Berdempes M, Markopoulos T, Lazarou L, Tzelves L, Skolarikos A. Patient positioning during percutaneous nephrolithotomy: what is the current best practice? Res Rep Urol 2018; 10:189-193. [PMID: 30464930 PMCID: PMC6214409 DOI: 10.2147/rru.s174396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Percutaneous nephrolithotomy (PCNL) is the gold standard procedure for treatment of large stones and complex kidney disorders, but its morbidity remains the highest among stone treatment procedures. In pursuit of minimizing complication rates, surgeons have developed different variations of the classic prone position in which PCNL is usually performed; one among them is supine position. In this study, we review the literature and present all available evidence on different variations in positioning during PCNL, in an effort to identify if there is a position that can minimize the morbidity of this procedure.
Collapse
Affiliation(s)
- Panagiotis Mourmouris
- Second Department of Urology, Athens Medical School, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece,
| | - Marinos Berdempes
- Second Department of Urology, Athens Medical School, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece,
| | - Titos Markopoulos
- Second Department of Urology, Athens Medical School, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece,
| | - Lazaros Lazarou
- Second Department of Urology, Athens Medical School, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece,
| | - Lazaros Tzelves
- Second Department of Urology, Athens Medical School, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece,
| | - Andreas Skolarikos
- Second Department of Urology, Athens Medical School, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece,
| |
Collapse
|