Supine PCNL: An alternative to prone PCNL. Initial experience

Stylianos Kontos, Athanasios Papatsoris, Sarath Krishna Nalagatla

Abstract


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.


Keywords


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

Full Text:

PDF

References


Fernstrom I, Johansson B. Percutaneous pyelolithotomy. A new extractiontechnique. Scand J Urol Nephrol 1976;10:257-259.

Alken P, Hutschenreiter G, Gunther R, et al. Percutaneous stone manipulation. J Urol 1981;125:463-466.

Valdivia JG, Scarpa RM, Duvdevani N, et al. Supine versus prone positionduring percutaneous nephrolithotomy: a report from the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study. J Endourol 2011;25:1619-1625.

Miano R, Scoffone C, De Nunzio C, et al. Position: prone or supine is the issue of percutaneous nephrolithotomy. J Endourol 2010;24:931-938.

Duty B, Waingankar N, Okhunov Z, et al. Anatomical variation betweenthe prone, supine, and supine oblique positions on computed tomography: implications for percutaneous nephrolithotomy access. Urology 2012;79:67-71.

de la Rosette JJ, Tsakiris P, Ferrandino MN, et al. Beyond prone position in percutaneous nephrolithotomy: A comprehensive review. Eur Urol 2008;54:1262-1269.

Valdivia Uria JG, Valle Gerhold J, Lopez Lopez JA, et al. Technique and complications of percutaneous nephroscopy: experience with 557 patients in the supine position. J Urol 1998;160:1975-1978.

Manohar T, Jain P, Desai M. Supine percutaneous nephrolithotomy: Effective approach to high-risk and morbidly obese patients. J Endourol 2007;21:44-49.

Yamaguchi A, Skolarikos A, Buchholz NP, et al. Operating times and bleeding complications in percutaneous nephrolithotomy: A comparison of tract dilation methods in 5,537 patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study. J Endourol 2011;25:933-939.

Liu L, Zheng S, Xu Y, et al. Systematic review and meta-analysis of percutaneous nephrolithotomy for patients in the supine versus prone position. J Endourol 2010;24:1941-1946.

Tuttle DN, Yeh BM, Meng MV, et al. Risk of injury to adjacent organs with lower-pole fluoroscopically guided percutaneous nephrostomy: evaluation with prone, supine, and multiplanar reformatted CT. J Vasc Interv Radiol 2005;16:1489-1492.

Steele D, Marshall V. Percutaneous nephrolithotomy in the supine position a neglected approach? J Endourol 2007;21:1433-1437.

Ibarluzea G, Scoffone CM, Cracco CM, et al. Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access. BJU Int 2007;100: 233-236.

Papatsoris AG, Zaman F, Panah A, et al. Simultaneous anterograde and retrograde endourologic access: ‘The Barts technique’. J Endourol 2008;22:2665-2666.

Tefekli A, Ali Karadag M, Tepeler K, et al. Classification of percutaneous nephrolithotomy complications using the modified clavien grading system: looking for a standard. Eur Urol 2008;53:184-190.

Kumar P, Bach C, Kachrillas S, et al. Supine percutaneous nephrolithotomy (PCNL): ‘in vogue’ but in which position? BJU Int 2012;110(11 Pt C):E1018-1021.

DasGupta R, Patel A. Percutaneous nephrolithotomy: does positionmatter? - prone, supine and variations. Curr Opin Urol. 2013; 23(2):164-8

De Sio M, Autorino R, Quarto G, et al. Modified supine versus prone position in percutaneous nephrolithotomy for renal stones treatable with a single percutaneous access: a prospective randomized trial. Eur Urol 2008;54:196-203.

Falahatkar S, Moghaddam AA, Salehi M, et al. Complete supine percutaneous nephrolithotripsy comparison with the prone standard technique. J Endourol 2008; 22:2513-2517.

Skolarikos A, Alivizatos G, de la Rosette JJMCH. Percutaneous nephrolithotomy and its legacy. Eur Urol 2005;47:22-28.

Wang Y, Jiang F, Wang Y, et al. Post-percutaneous nephrolithotomy septic shock and severe hemorrhage: a study of risk factors. Urol Int 2012;88:307-310.

Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy. Eur Urol 2007;51:899-906.

Bach C, Goyal A, Kumar P, Kachrilas S, Papatsoris AG, Buchholz N, Masood J The Barts ‘flank-free’ modified supine position for percutaneous nephrolithotomy..Urol Int. 2012;89(3):365-8. doi: 10.1159/000341430. Epub 2012 Oct 5. J Endourol. 2009 Oct;23(10):1603-6. doi: 10.1089/end.2009.1525.

El-Husseiny T1, Moraitis K, Maan Z, Papatsoris A, Saunders P, Golden B, Masood J, Buchholz NP. Percutaneous endourologic procedures in high-risk patients in the lateral decubitus position under regional anesthesia. J Endourol. 2009 Oct;23(10):1603-6. doi: 10.1089/end.2009.1525.25.

Papatsoris A1, Masood J, El-Husseiny T, Maan Z, Saunders P, Buchholz NP. Improving patient positioning to reduce complications in prone percutaneous nephrolithotomy. J Endourol. 2009 May;23(5):831-2. doi: 10.1089/end.2008.0611.




DOI: http://dx.doi.org/10.19264/hj.v27i1.34