Waleed El-Shaer1, Wael Kandeel2, Sally Abdel-Lateef3, Ahmed Torky3, Alaa Elshaer2. 1. Department of Urology, Benha University Hospital, Egypt. Electronic address: waleed_elshaer@hotmail.com. 2. Department of Urology, Benha University Hospital, Egypt. 3. Department of Radiology, Benha University Hospital, Egypt.
Abstract
OBJECTIVES: To evaluate the safety, efficacy, adverse events, and feasibility of ultrasound guided percutaneous nephrolithotomy (US-PCNL) in the management of large renal stones in supine and prone positions and to point out the practical considerations related to these techniques in comparison with standard PCNL. PATIENTS AND METHODS: This study was conducted between August 2013 to September 2018 as a prospective randomized and controlled study. A total of 392 consecutive patients with nephrolithiasis >2 cm were randomly assigned to undergo ultrasound PCNL in prone (P-US-PCNL) (132 patients); supine position (S-US-PCNL) (129 patients) or conventional PCNL (C-PCNL) (131 patients). The preoperative parameters, the intraoperative findings, operative time, hospital stay, perioperative morbidities, stone free rate, and related data were recorded. RESULTS: The demographic and the baseline characteristics were comparable in all study groups. The mean number of trails and time for successful puncture in P-US-PCNL, S-US-PCNL, and C-PCNL were 1.9 ± 1, 2.3 ± 1.2, and 1.7±1, respectively (P < .001), and 15.8 ± 5.8, 19.3 ± 9.4, and 16.5 ± 8.1 seconds, respectively (P < .001). The operation time was 69 ± 22, 75 ± 23, and 72 ± 27 minutes, respectively, (P > .05). The mean nephrostomy time and length of hospital stay were 3 ± 1.3, 3.4 ± 1.5, 3.2 ± 1.2 hours, respectively, and 3.8 ± 1.5, 4.1 ± 1.5, 3.9 ± 1.3 days, respectively (P > .05). The mean percentage decrease in hemoglobin concentration was 1.65 ± 0.66, 1.77 ± 0.78, and 2.1 ± 0.9, respectively (P < .001), overall stone clearance was 88%, 79%, and 85%, respectively (P > .05). Complications were acceptable and similar between groups. CONCLUSION: US-PCNL either in prone or supine position is as effective, feasible, and safe as C-PCNL with zero radiation exposure.
RCT Entities:
OBJECTIVES: To evaluate the safety, efficacy, adverse events, and feasibility of ultrasound guided percutaneous nephrolithotomy (US-PCNL) in the management of large renal stones in supine and prone positions and to point out the practical considerations related to these techniques in comparison with standard PCNL. PATIENTS AND METHODS: This study was conducted between August 2013 to September 2018 as a prospective randomized and controlled study. A total of 392 consecutive patients with nephrolithiasis >2 cm were randomly assigned to undergo ultrasound PCNL in prone (P-US-PCNL) (132 patients); supine position (S-US-PCNL) (129 patients) or conventional PCNL (C-PCNL) (131 patients). The preoperative parameters, the intraoperative findings, operative time, hospital stay, perioperative morbidities, stone free rate, and related data were recorded. RESULTS: The demographic and the baseline characteristics were comparable in all study groups. The mean number of trails and time for successful puncture in P-US-PCNL, S-US-PCNL, and C-PCNL were 1.9 ± 1, 2.3 ± 1.2, and 1.7±1, respectively (P < .001), and 15.8 ± 5.8, 19.3 ± 9.4, and 16.5 ± 8.1 seconds, respectively (P < .001). The operation time was 69 ± 22, 75 ± 23, and 72 ± 27 minutes, respectively, (P > .05). The mean nephrostomy time and length of hospital stay were 3 ± 1.3, 3.4 ± 1.5, 3.2 ± 1.2 hours, respectively, and 3.8 ± 1.5, 4.1 ± 1.5, 3.9 ± 1.3 days, respectively (P > .05). The mean percentage decrease in hemoglobin concentration was 1.65 ± 0.66, 1.77 ± 0.78, and 2.1 ± 0.9, respectively (P < .001), overall stone clearance was 88%, 79%, and 85%, respectively (P > .05). Complications were acceptable and similar between groups. CONCLUSION: US-PCNL either in prone or supine position is as effective, feasible, and safe as C-PCNL with zero radiation exposure.