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.
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.
Authors: Luis Llanes; Javier Sáenz; Mikel Gamarra; Daniel A Pérez; Alvaro Juárez; Camilo García; José M Arroyo; Gaspar Ibarluzea Journal: Urolithiasis Date: 2013-04-16 Impact factor: 3.436
Authors: Silvia Proietti; Moises Elias Rodríguez-Socarrás; Brian Eisner; Vincent De Coninck; Mario Sofer; Giuseppe Saitta; Maria Rodriguez-Monsalve; Carlo D'Orta; Piera Bellinzoni; Franco Gaboardi; Guido Giusti Journal: Transl Androl Urol Date: 2019-09
Authors: Mario Sofer; Eli Tavdi; Oleg Levi; Ishay Mintz; Yuval Bar-Yosef; Ami Sidi; Haim Matzkin; Alexander Tsivian Journal: Cent European J Urol Date: 2017-03-14
Authors: Hani H Nour; Ahmed M Kamal; Samir E Ghobashi; Ahmed S Zayed; Mamdouh M Rushdy; Ahmed G El-Baz; Ahmed I Kamel; Tarek El-Leithy Journal: Arab J Urol Date: 2013-02-04