Modified Supine Percutaneous Nephrolithotomy For Large Kidney And Ureteral Stones: Technique And Results.
Published 2012 · Medicine
BACKGROUND Percutaneous nephrolithotomy (PCNL) is the standard treatment for kidney stones >2cm. Recently, a novel approach in the modified supine lithotomy position has been developed. OBJECTIVE To demonstrate with a video our technique of supine PCNL (sPCNL) and present our experience. DESIGN, SETTING, AND PARTICIPANTS From September 2009 to August 2010, 47 consecutive patients were prospectively evaluated. There were 31 single, 9 multiple, and 7 staghorn stones. The mean body mass index was 26.1±5 (range: 17.3-45.7), the mean stone size was 29.6±15.3mm (range: 10-75), and patients' American Society of Anesthesiologists scores were 1, 2, and 3 in 31, 11, and 5 cases, respectively. SURGICAL PROCEDURE Patients were positioned in Galdakao-modified supine Valdivia position. The details of the technique are shown in the film. MEASUREMENTS Success was defined as patients free of stones or with residual stone fragments <4mm. RESULTS AND LIMITATIONS Average operative room occupation time was 123.5±51.2min (range: 50-245). In the single, multiple, and staghorn stone groups, the immediate success rate after sPCNL was 90%, 78%, and 43%, respectively. Complications included one fever, two incidents of pyelonephritis, one renal colic, two urinary fistulae, one postoperative hemorrhage, and one incident of acute urinary retention. Mean hospital stay was 3.4±1.9 d (range: 2-12). Nine patients (19%) had a secondary procedure (extracorporeal shock wave lithotripsy or flexible ureterorenoscopy). At 3 mo, the success rate was 97%, 100%, and 100% in the single, multiple, and staghorn stone groups, respectively. However, the limitation of this study is its design, which is descriptive rather than comparative. CONCLUSIONS sPCNL is a safe and reproducible method. It offers the advantage of simultaneous retrograde and antegrade endoscopic combined intrarenal surgery, and we believe it is a further advancement in stone management. In addition, it is easier from the anesthetist point of view than the traditional prone approach. In our hands, it meant a simplification of the operative technique, resulting in a more time-efficient procedure.