Supine PCNL: An alternative to prone PCNL. Initial experience

Stylianos Kontos, Athanasios Papatsoris, Sarath Krishna Nalagatla


The last decade has seen the emergence of a variety of  positions for carrying out percutaneous nephrolithotomy (PCNL). An alternative position for PCNL consists of the modified supine position, in which patients are placed in a supine position with a water bag or specially designed cushion under the flank in order to ease of puncture under image guidance, operative field availability, ability to make and dilate multiple tracts and ease of combining retrograde intrarenal surgery (RIRS). We describe and illustrate our supine position, which we believe addresses a number of the issues.Our position allows easy percutaneous access under fluoroscopy (torso only tilted to around 15°), space for placing (flank free of support) and dilating multiple tracts (kidney lies in a fairly neutral position and hence less mobile), a fairly horizontal tract allowing low intrarenal pressures and easy washout of fragments. The study showed that PCNL in the supine position is an effective and safe method for treating urinary stones. We would like to highlight the supine position as one of the standard positions for carrying out  PCNL.

Την τελευταία δεκαετία έχουν προταθεί  ποικιλία  θέσεων της διαδερμικής νεφρολιθοτριψίας (PCNL). Μία εναλλακτική θέση για PCNL είναι ύπτια θέση που υπερτερεί έναντι της κλασσικής πρήνους, λόγω της ευκολότερης πρόσβασης στον αεραγωγό και στη μικρότερη επιβάρυνση των ασθενών υψηλού κινδύνου, αποτρέποντας τις αναπνευστικές και καρδιαγ­γειακές επιπλοκές και προσφέροντας ευκολότερη πρόσβαση στο αναπνευστικό σύστημα του ασθενούς αλλά και μείωση των επιπλοκών από το γαστρενετερικό λόγω της θέσης του εντέρου προσφέροντας τη δυνατότητα  της ταυτόχρονης χρήσης εύκαμπτης ουρητηροσκόπησης. Η εμπειρία μας έδειξε ότι PCNL σε ύπτια θέση είναι μια αποτελεσματική και ασφαλής μέθοδος για την αντιμετώπιση ευμεγέθους νεφρολιθίασης.


percutaneous nephrolithotomy; supine position; prone position;διαδερμική νεφρολιθοτομή;ύπτια θέση;πρηνής θέση

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