Is complete supine percutaneous nephrolithotripsy feasible in all patients?

Although complete supine percutaneous nephrolithotomy (csPCNL) is routine in some surgical centers throughout the world, its popularity in the field of urology due to a deficiency in its training in educational centers, as a whole, is still minimal. We evaluated the outcomes of tubeless csPCNL in this study. This study was a clinical trial, conducted by one surgical team from January 2009 to January 2010, on 117 patients in complete supine position. Percutaneous access was created under fluoroscopic or ultrasonographic guidance in complete supine position. All patients underwent csPCNL without nephrostomy tube (tubeless). Stone disintegration was performed with pneumatic lithotripsy. Pre- and post-operative data of patients were evaluated. The mean operative time was 98 min. The mean reduction in hemoglobin level was 1.5 g/dl. A total of 129 punctures (105 single and 12 double) was performed. The ureteral catheter was left for 1-3 days. The mean hospital stay was 3.7 days. The stone-free rate was 77.77%. Seventeen patients required blood transfusion. Eight patients had fever. Fistula, extravasation or wound infection did not occur. This study demonstrated that csPCNL is a good option for all patients. Furthermore, csPCNL offers potential advantages including better urethral access, less handling of patients, better control of the airway during procedures and reducing overall operative time, a surgeon seated more comfortably, no density overlap with vertebra, easier access to upper calyces, more rapid access to the airway with less hazard, especially in patients with compromised cardiopulmonary function and morbid obesity.