Percutaneous Nephrolithotripsy in the Position of the Patient Lying on His Back
##plugins.themes.bootstrap3.article.sidebar##
##plugins.themes.bootstrap3.article.main##
Abstract
The objective: evaluation of the effectiveness and safety of percutaneous nephrolithotripsy in patients in the supine position.
Materials and methods. For the period 2017–2021, 521 mini-PNL were performed according to the standard technique, where in 458 (87,9%) cases the operation was performed in the patient’s prone position, and in 63 (12,1%) cases on the supine position (group 1). The control group (2 group) consisted of 70 patients, sporadically selected among 458 patients to whom PML performed in a standard prone position. Mini-PNL was performed under combined regional (spinal-epidural) anesthesia in 98,7% (514) cases, in 1,3% (7) under endotrachial anesthesia.
Results. The average time of surgery was 41,1±11,4 minutes in the 1st group and 57,4±10,3 minutes in the 2nd group (р<0,05), due to the lack of need to revolutionize the patient on the abdomen. Statistically greater (p<0,05) of the ability to perform/ additional percutaneous access in patients in the supaine position. Infectious complications (9,5 vs. 7,1%; p>0,05), stone-free conditions (96,4 vs. 98,2%; p>0,05) and average hospital stays (2,3 vs. 2,2 days; p>0,05).
None of the patients in both groups had complications higher than Clavien IIIa. When performing PNL in the supine position, in contrast to performing PNL on the prone position, there is always the possibility of using combined endoscopic methods. Where 3 (4,8%) patients underwent combined retro- and antegrade approaches for combination of nephrolithiasis with «wedged» calculi of the pyelourethral segment and in distal ureter, and retrograde laser endoureterotomy was performed in one (1,6%) patient. The limitation of our study includes a small sample size and a lack of group randomization.
Conclusions. The patient’s position on the supine position, during the implementation of PNL, is a safe technique and can be a particularly attractive option for the category of patients with high anesthesiological risk; in the case of planned simultane (transurethral and percutaneous) interventions on the UMP; in patients who are obese or with severe deformityof the spine.
##plugins.themes.bootstrap3.article.details##
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain the copyright and grant the journal the first publication of original scientific articles under the Creative Commons Attribution 4.0 International License, which allows others to distribute work with acknowledgment of authorship and first publication in this journal.
References
Fernstrom I., Johansson B. Percutaneous pyelolithotomy: a new extraction technique. Scand. J. Urol. Nephrol. 1976;10: 257–9.
De la Rosette J., Assimos D., Desai M. et al. The clinical research office of the endourological society percutaneous nephrolithotomy global study: indications, complications and outcomes in 5803 patients. J. Endourol. 2011;25(1):11–7.
Miano R., Scoffone C., De Nunzio C., Germani S., Cracco C., Usai P., et al. Position: prone or supine is the issue of percutaneous nephrolithotomy. J. Endourol. 2010;24(6):931–8.
Peces-Barba G., Rodriguez-Nieto M.J., Verbank S. et al. Lower pulmonary diffusing capacity in prone vs supine posture.J. Appl. Physiol. 2004;96;1937–42.
Valdivia G.J., Valle J., Lopez J.A. et al. Technique and complications of percutaneous nephroscopy: experience with 557 patients in supine position. J. Urol. 1998;160:1975–8.
Lehman T., Bagley D.H. Reverse lithotomy: modified prone position for simultaneous nephroscopic and ureteroscopic procedures in women. Urology. 1988;32:529–31.
Ibarlusea G., Scoffone C., Cracco C. et al. Supine Valdivia and modified lithotomy position for simultaneous antegrade and retrograde endourological access. BJU Int. 2007;100:133–6.
Birowo P., Tendi W., Widyahening IS., Rasyid N., Atmoko W. Supine versus prone position in percutaneous nephrolithotomy: a systematic review and metaanalysis. F1000Res. 2020;2,9:231. DOI: 10.12688/f1000research.22940.3.
Li J., Gao L., Li Q., Zhang Y., Jiang Q. Supine versus prone position for percutaneous nephrolithotripsy: A meta-analysis of randomized controlled trials. Int J Surg. 2019; 66: 62–71. doi: 10.1016/j.ijsu.2019.04.016.
Keller E., Coninck V., Proietti S., Talso M., Emiliani E., Ploumidis A., Mantica G., Somani B., Traxer O., Scarpa R., Esperto F. European Association of Urology – European Society of Residents in Urology (EAU-ESRU). Prone versus supine percutaneous nephrolithotomy: a systematic review and meta-analysis of current literature. Minerva Urol Nephrol. 2021;73(1):50–8. DOI: 10.23736/S2724-6051.20.03960-0.
Türk C., Skolarikos A., Neisius A., Petřík A., Seitz C., Thomas K. Guidelines on urolithiasis. European Association of Urology. European Association of Urology, 2021 [internet publication]. URL: http://uroweb.org/guideline/urolithiasis.
Cracco C.M, Scoffone C.M. ECIRS (Endoscopic combined intrarenal surgery) in the Galdakao-modified Valdivia position: a new life for percutaneous surgery? World J. Urol. 2011;29(6):821–7.
Hoznek A., Rode J., Ouzaid I., Faraj B., Kimuli M., et al. Modifeid supine percutaneous nephrolithotomy for large kidney and ureteral stones: technique and results. Eur. Urol. 2012;61(1):164–70.
Peces-Barba G., Rodriguez-Nieto M.J., Verbank S. et al. Lower pulmonary diffusing capacity in prone vs supine posture. J. Appl. Physiol. 2004;96:1937–42.
Pump B., Talleruphuus U., Christensen N. et al. Effects of supine, prone, and lateral positions on cardiovascular and renal variables in humans. Am. J. Physiol. Regul. Integr. Comp. Physiol. 2002;283:174–80.
El-Hahas A.R., Shokeir A.A., El-Assmy A.M. et al. Colonic perforation during percutaneous nephrolithotomy: study of risk factors. Urology. 2006;67:937–41.
Korkes F., Neto A., Lucio J. et al. Management of colon injury after percutaneous renal surgery.J. Endourol. 2009;23(4):569–73.
Le Roy A.J., Williams H.J., Bender C.E. et al. Colon perforation following percutaneous nephrostomy and renal calculus removal. Radiology.1985;155:83–85.
Valdivia J., Scarpa R., Duvdevani M., Gross A., Nadler R., Nutahara K., et al. Supine versus prone position during percutaneous nephrolithotomy: a report from the clinical research office of the endourological society percutaneous nephrolithotomy global study. J Endourol. 2011;25(10):1619–25.
Liu L., Zheng S., Xu Y., Wei Q. Systematic review and meta-analysis of percutaneous nephrolithotomy for patients in the supine versus prone position. J Endourol. 2010;24(12):1941–6.
Wang Y., Yao Y., Xu N., Zhang H., Chen Q., Lu Z., et al. Prone versus modified supine position in percutaneous nephrolithotomy: a prospective randomized study. Int J Med Sci. 2013;10(11):1518–23.
De Sio M., Autorino R., Quarto G., Calabrò F., Damiano R., Giugliano F., 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(1):196–202.
Falahatkar S., Moghaddam A., Salehi M., Nikpour S., Esmaili F., Khaki N. Complete supine percutaneous nephrolithotripsy comparison with the prone standard technique. J Endourol. 2008;22(11):2513–7.
Cracco C.M., Scoffone C.M. ECIRS (Endoscopic combined intrarenal surgery) in the Galdakao-modified Valdivia position: a new life for percutaneous surgery? World J. Urol. 2011;29(6):821–7.
Ibarlusea G., Scoffone C., Cracco C. et al. Supine Valdivia and modified lithotomy position for simultaneous antegrade and retrograde endourological access. BJU Int. 2007;100:133–6.
Falahatkar S., Mokhtari G., Teimoori M. An Update on Supine Versus Prone Percutaneous Nephrolithotomy: A Meta-analysis. Urol J. 2016; Oct.10;13(5):2814–22.
Loftus C., Hinck B., Makovey I., Sivalingam S,. Monga M. Mini Versus Standard Percutaneous Nephrolithotomy: The Impact of Sheath Size on Intrarenal Pelvic Pressure and Infectious Complications in a Porcine Model. J Endourol. 2018;32(4):350–3. DOI: 10.1089/end.2017.0602
Melo P., Vicentini F., Perrella R., Murta C., Claro J. Comparative study of percutaneous nephrolithotomy performed in the traditional prone position and in three different supine positions. Int Braz J Urol. 2019;45(1):108–17.
William T. Supine versus Prone Position in Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis. OSF. 2020. September 8. DOI:10.17605/OSF.IO/GDH3R.
