Comparing prone to modified supine percutaneous nephrolithotomy – a single surgeon experience....
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Comparing prone to modified supine percutaneous nephrolithotomy – a single surgeon experience. Introduction Percutaneous Nephrolithotomy (PCNL) is traditionally
Comparing prone to modified supine percutaneous nephrolithotomy
a single surgeon experience. Introduction Percutaneous
Nephrolithotomy (PCNL) is traditionally performed in the prone
position. This has significant anaesthetic ramifications and is
time consuming. A modified supine PCNL has been described, which is
a technique that has many anaesthetic 1 and operative benefits.
These include the ability to simultaneously treat ureteric calculi,
thereby avoiding additional procedures; decreased manual handling
of the patient and decreased operating time 2. Despite these
benefits, it is not common practice in Australia due to lack of
training and fear of complications. Conclusions Despite only
recently being introduced to our unit, the results of the modified
supine PCNL have been equivalent to the previous prone cases with a
significant reduction in operating time. This is despite the
increasing stone complexity and increased BMI in the supine series.
Most of this reduction will be due to the avoidance of
repositioning, though other advantages have included gravity
induced stone expulsion and simultaneous ureteric stone treatment.
We strongly feel that the modified supine position is superior to
the prone and should now be used routinely for all large
renal/proximal ureteric stones. Results Groups were well matched
for age. 3 of the supine group were not considered fit enough for
prone procedures due to morbid obesity and pre-existing chest
problems. Operating time for the supine group was significantly
shorter than for the prone group (median time 86 minutes v 116
minutes, range 39-145 v 55-270). Complications were similar in both
groups with no significant difference between the two. One patient
from the supine group was converted to prone after an unsuccessful
puncture. This was the 5 th patient in the supine series, and was
considered to be part of our learning curve. Methods 41 consecutive
modified supine PCNLs were performed between April 2011 and March
2012. 41 operations were performed on 36 patients (5 patients had
re-PCNL) with large renal calculi or ureteric calculi >2cm. A
single Consultant surgeon was involved, with 7 different trainees
performing punctures (3 registrars and 4 fellows) These were his
first 41 PCNLs performed in a supine position. Data for the supine
cohort was collected prospectively All patients were followed up
with X-ray or CT KUB Stones were fragmented using either a
lithoclast or ultrasonic lithotripter. For complex staghorn
calculi, a second surgeon performed simultaneous ureterorenoscopy
using the Holmium:YAG laser for fragmentation. The patient
demographics, stone size, operating time and clearance rates were
compared to the immediate previous 41 prone cases (36 patients) and
analysed statistically. Aim We have recently changed from offering
routine prone position for PCNL to a modified supine technique. We
have compared our first 41 modified supine cases with the previous
41 prone cases. References 1 Atkinson C, Turney B, Noble J, Reynard
J, Stoneham M. Supine vs Prone Percutaneous Nephrolithotomy: An
anesthetist's view. BJUI. 2011; Aug; 108(3) 306-8. 2 Wu P, Wang L,
Wang K. Supine versus prone position in percutaneous
nephrolithotomy for kidney calculi: a meta-analysis. Int Urol
Nephrol. 2011; 43:67-77 K. Rzetelski-West, Jacob Gleeson, Phil
McCahy Department of Urology, Casey Hospital, Berwick, Victoria
Poster presentation sponsor No. 046 CharacteristicsProneSupineP
value Age (years) Median: Range: 53.1 18-82 53.4 19-82 p=0.954
Male:Female15:2626:15 Body Mass Index (BMI)26.731.3p=0.067
Operating time (minutes) Median: Range: 116.6 55-270 86.2 39-145 p=
0.003* Stone Size (mm)25.732.6p=0.0402* Additional ureteric
calculi07 Length of Stay (days)2.5 p=0.9136