Mehmet Yıldızhan1, Emre Salabaş2. 1. Department of Urology. Ankara City Hospital. Ankara. Turkey. 2. Department of Urology. Şişli Hamidiye Etfal Training and Research Hospital. İstanbul. Turkey.
Abstract
OBJECTIVE: To compare the efficacy and safety of prone and supine percutaneous nephrolithotomy (P/SPNL) with special emphasis on tubeless (T) and totally tubeless (TT) surgery. MATERIAL AND METHODS: This retrospective, single-surgeon, consecutive series comparison study involved 361 consecutive patients who under went PNL operations in either the prone or Galdakao-modified Valdivia supine positions between September 2016 and March 2020. Indication for surgery was a stone diameter greater than 2 cm. The two groups were compared in terms of preoperative demographics, stone parameters, and perioperative data. RESULTS: The groups were similar in terms of preoperative demographics, while the blood transfusion rate was insignificantly higher in PPNL (7% vs 3.3%, p=0.165). Mean operative time (58.0±20.6 vs 54.1±15.9 min., respectively, p=0.165), fluoroscopy time (p=0.895), and Clavien complication rates (p=0.87) were similar. SPNL exhibited a significantly (p<0.001) higher rate of T operations (23, 37.7%) than PPNL (46, 15.3%). TT cases were also higher with SPNL (14% vs 29.5%,p=0.003). Urine leakage (p=0.085) and post-operative JJ stent placement (p=0.180) rates were statistically similar between the two groups. Length of hospital stay was approximately one day shorter for T cases in both groups (PPNL: 1.37±0.80 vs 2.26±1.28 days, p=0.001; SPNL: 1.65±0.83 vs 2.76±2.27 days, p=0.028). Stone free rates were 91.3% and 88.5% for PPNL and SPNL, respectively (p=0.488). CONCLUSION: SPNL has proved to be as safe and effective as its prone counter part, with similar stone-free and complication rates. T and TT-PNL seem more viable with SPNL, which will increase patient comfort and allow shorter hospitalization times.
OBJECTIVE: To compare the efficacy and safety of prone and supine percutaneous nephrolithotomy (P/SPNL) with special emphasis on tubeless (T) and totally tubeless (TT) surgery. MATERIAL AND METHODS: This retrospective, single-surgeon, consecutive series comparison study involved 361 consecutive patients who under went PNL operations in either the prone or Galdakao-modified Valdivia supine positions between September 2016 and March 2020. Indication for surgery was a stone diameter greater than 2 cm. The two groups were compared in terms of preoperative demographics, stone parameters, and perioperative data. RESULTS: The groups were similar in terms of preoperative demographics, while the blood transfusion rate was insignificantly higher in PPNL (7% vs 3.3%, p=0.165). Mean operative time (58.0±20.6 vs 54.1±15.9 min., respectively, p=0.165), fluoroscopy time (p=0.895), and Clavien complication rates (p=0.87) were similar. SPNL exhibited a significantly (p<0.001) higher rate of T operations (23, 37.7%) than PPNL (46, 15.3%). TT cases were also higher with SPNL (14% vs 29.5%,p=0.003). Urine leakage (p=0.085) and post-operative JJ stent placement (p=0.180) rates were statistically similar between the two groups. Length of hospital stay was approximately one day shorter for T cases in both groups (PPNL: 1.37±0.80 vs 2.26±1.28 days, p=0.001; SPNL: 1.65±0.83 vs 2.76±2.27 days, p=0.028). Stone free rates were 91.3% and 88.5% for PPNL and SPNL, respectively (p=0.488). CONCLUSION: SPNL has proved to be as safe and effective as its prone counter part, with similar stone-free and complication rates. T and TT-PNL seem more viable with SPNL, which will increase patient comfort and allow shorter hospitalization times.