Chonnam Med J.  2014 Aug;50(2):52-57. 10.4068/cmj.2014.50.2.52.

Feasibility and Efficacy of Intermediate-Supine Percutaneous Nephrolithotomy: Initial Experience

Affiliations
  • 1Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. kscho99@yuhs.ac
  • 2Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.

Abstract

We evaluated the feasibility and efficacy of intermediate-supine percutaneous nephrolithotomy (PCNL) in patients with renal calculi. Fifteen patients were included in this study. The intermediate-supine operative position was modified by using a 1-L saline bag below the ipsilateral upper flank. A nephrostomy and stone extraction were performed as usual. After completion of the stone removal, a nephrostomy tube was used when necessary according to the surgeon's decision. If there was no significant bleeding or renal pelvic injury, tubeless PCNL was performed. The mean stone size was 5.48+/-5.69 cm2, the mean operative time was 78.93+/-38.72 minutes, and the mean hospital stay was 2.60+/-1.29 days. Tubeless PCNL was performed in 13 cases (86.7%), and retrograde procedures were simultaneously performed without a change of position in 2 patients (ureteroscopic ureterolithotomy in one patient and transurethral placement of an occlusion catheter in one patient). There were two complications according to the Clavien-Dindo classification (Grade I in one patient and Grade II in one patient). The success rate was 80.0% and the complete stone-free rate was 73.3%. Three patients with a significant remnant stone were also successfully managed with additional procedures (one patient underwent a second-look operation, and the remaining two patients were treated with shock wave lithotripsy). In the treatment of renal calculi, intermediate-supine PCNL may be a safe and effective choice that offers several advantages with excellent outcomes. Thus, a prospective study with a larger population is needed to verify our outcomes.

Keyword

Kidney calculi; Supine position; Nephrostomy

MeSH Terms

Catheters
Classification
Hemorrhage
Humans
Kidney Calculi
Length of Stay
Nephrostomy, Percutaneous*
Operative Time
Shock
Supine Position

Figure

  • FIG. 1 Intermediate supine and tubeless percutaneous nephrolithotomy. (A) The position was modified using a one liter saline bag below the ipsilateral upper flank in a male patient. (B) Renal stones were removed using LithoClast by the operator and assistant who were seated during the procedure. (C) There was no nephrostomy catheter placed in the puncture site in a female patient after operation.


Cited by  1 articles

Real-time simultaneous endoscopic combined intrarenal surgery with intermediate-supine position: Washout mechanism and transport technique
Hae Do Jung, Jong Chan Kim, Hyun Kyu Ahn, Joon Ho Kwon, Kichang Han, Woong Kyu Han, Man-Deuk Kim, Joo Yong Lee
Investig Clin Urol. 2018;59(5):348-354.    doi: 10.4111/icu.2018.59.5.348.


Reference

1. Segura JW, Patterson DE, LeRoy AJ, May GR, Smith LH. Percutaneous lithotripsy. J Urol. 1983; 130:1051–1054. PMID: 6644881.
2. Kerbl K, Clayman RV, Chandhoke PS, Urban DA, De Leo BC, Carbone JM. Percutaneous stone removal with the patient in a flank position. J Urol. 1994; 151:686–688. PMID: 8308982.
3. Valdivia Uría JG, Valle Gerhold J, López López JA, Villarroya Rodriguez S, Ambroj Navarro C, Ramirez Fabián M, et al. Technique and complications of percutaneous nephroscopy: experience with 557 patients in the supine position. J Urol. 1998; 160:1975–1978. PMID: 9817303.
4. Kwon S, Kim HG. A comparative study between standard and tubeless percutaneous nephrolithotomy. Korean J Urol. 2007; 48:45–48.
5. Jeong WJ, Jeon HG, Yang SC, Han WK. Percutaneous nephrolithotomy in a semi-lateral position. Korean J Urol. 2009; 50:892–896.
6. Clayman RV, Bub P, Haaff E, Dresner S. Prone flexible cystoscopy: an adjunct to percutaneous stone removal. J Urol. 1987; 137:65–67. PMID: 3795367.
7. Istanbulluoglu MO, Cicek T, Ozturk B, Gonen M, Ozkardes H. Percutaneous nephrolithotomy: nephrostomy or tubeless or totally tubeless? Urology. 2010; 75:1043–1046. PMID: 19854490.
8. Paul EM, Marcovich R, Lee BR, Smith AD. Choosing the ideal nephrostomy tube. BJU Int. 2003; 92:672–677. PMID: 14616443.
9. Tiselius HG, Andersson A. Stone burden in an average Swedish population of stone formers requiring active stone removal: how can the stone size be estimated in the clinical routine? Eur Urol. 2003; 43:275–281. PMID: 12600431.
10. Park J, Hong B, Park T, Park HK. Effectiveness of noncontrast computed tomography in evaluation of residual stones after percutaneous nephrolithotomy. J Endourol. 2007; 21:684–687. PMID: 17705749.
11. Shin TS, Cho HJ, Hong SH, Lee JY, Kim SW, Hwang TK. Complications of percutaneous nephrolithotomy classified by the modified clavien grading system: a single center's experience over 16 years. Korean J Urol. 2011; 52:769–775. PMID: 22195267.
12. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240:205–213. PMID: 15273542.
13. Rana AM, Bhojwani JP, Junejo NN, Das Bhagia S. Tubeless PCNL with patient in supine position: procedure for all seasons?--with comprehensive technique. Urology. 2008; 71:581–585. PMID: 18279935.
14. 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; 54:196–202. PMID: 18262711.
15. Karami H, Mohammadi R, Lotfi B. A study on comparative outcomes of percutaneous nephrolithotomy in prone, supine, and flank positions. World J Urol. 2013; 31:1225–1230. PMID: 22692449.
16. Shoma AM, Eraky I, El-Kenawy MR, El-Kappany HA. Percutaneous nephrolithotomy in the supine position: technical aspects and functional outcome compared with the prone technique. Urology. 2002; 60:388–392. PMID: 12350467.
17. Hoznek A, Rode J, Ouzaid I, Faraj B, Kimuli M, de la Taille A, et al. Modified supine percutaneous nephrolithotomy for large kidney and ureteral stones: technique and results. Eur Urol. 2012; 61:164–170. PMID: 21570174.
18. Xu KW, Huang J, Guo ZH, Lin TX, Zhang CX, Liu H, et al. Percutaneous nephrolithotomy in semisupine position: a modified approach for renal calculus. Urol Res. 2011; 39:467–475. PMID: 21336573.
19. Ng MT, Sun WH, Cheng CW, Chan ES. Supine position is safe and effective for percutaneous nephrolithotomy. J Endourol. 2004; 18:469–474. PMID: 15253823.
20. Segura JW, Patterson DE, LeRoy AJ, Williams HJ Jr, Barrett DM, Benson RC Jr, et al. Percutaneous removal of kidney stones: review of 1,000 cases. J Urol. 1985; 134:1077–1081. PMID: 4057395.
21. Basiri A, Mohammadi Sichani M. Supine percutaneous nephrolithotomy, is it really effective? A systematic review of literature. Urol J. 2009; 6:73–77. PMID: 19472122.
22. Hopper KD, Sherman JL, Luethke JM, Ghaed N. The retrorenal colon in the supine and prone patient. Radiology. 1987; 162:443–446. PMID: 3797658.
23. Papatsoris A, Masood J, El-Husseiny T, Maan Z, Saunders P, Buchholz NP. Improving patient positioning to reduce complications in prone percutaneous nephrolithotomy. J Endourol. 2009; 23:831–832. PMID: 19422310.
24. Pelosi P, Croci M, Calappi E, Cerisara M, Mulazzi D, Vicardi P, et al. The prone positioning during general anesthesia minimally affects respiratory mechanics while improving functional residual capacity and increasing oxygen tension. Anesth Analg. 1995; 80:955–960. PMID: 7726438.
25. Marchant F, Recabal P, Fernández MI, Osorio F, Benavides J. Postoperative morbidity of tubeless versus conventional percutaneous nephrolithotomy: a prospective comparative study. Urol Res. 2011; 39:477–481. PMID: 21337032.
26. Bellman GC, Davidoff R, Candela J, Gerspach J, Kurtz S, Stout L. Tubeless percutaneous renal surgery. J Urol. 1997; 157:1578–1582. PMID: 9112480.
27. Sofikerim M, Demirci D, Huri E, Erşekerci E, Karacagil M. Tubeless percutaneous nephrolithotomy: safe even in supracostal access. J Endourol. 2007; 21:967–972. PMID: 17941770.
28. Shen P, Liu Y, Wang J. Nephrostomy tube-free versus nephrostomy tube for renal drainage after percutaneous nephrolithotomy: a systematic review and meta-analysis. Urol Int. 2012; 88:298–306. PMID: 22414703.
29. Zilberman DE, Lipkin ME, de la Rosette JJ, Ferrandino MN, Mamoulakis C, Laguna MP, et al. Tubeless percutaneous nephrolithotomy--the new standard of care? J Urol. 2010; 184:1261–1266. PMID: 20723920.
30. Leibovici D, Cooper A, Lindner A, Ostrowsky R, Kleinmann J, Velikanov S, et al. Ureteral stents: morbidity and impact on quality of life. Isr Med Assoc J. 2005; 7:491–494. PMID: 16106772.
Full Text Links
  • CMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr