Supine PCNL-5 year experience in a tertiary care center

Objective: The prone position for percutaneous nephrolithomy (PCNL) has been widely practiced. There has been a shift from prone position to supine position which showed numerous benefits. The aim of our study is to describe the 5 year experience from the perspective of a tertiary care center using a modified Galdakao supine Valdivia position for total tubeless ultra mini supine PCNL, total tubeless supine PCNL, tubeless supine PCNL, and standard supine PCNL. Material and methods: We retrospectively reviewed the data of 90 patients who underwent supine PCNL at the tertiary care center during the period of 5 years from January 2017 to January 2021. The data collection was done from patients’ medical records. Pre operatively, complete examination of the patients with laboratory investigations were done. The modified Clavien classification system was used to classify the perioperative complications of PCNL. Results: Operative time was lowest for ultra mini supine PCNL (50 ± 10.4 min) compared to standard supine PCNL (58 ± 11.2 min). Stones were single in 54 patients and multiple in 40 patients with 4 patients with staghorn stones. The size of the stones in the largest dimension ranged from 1.2 to 5.5 cm.Complete clearance was achieved in 84 (89.7%) patients. Seven patients (7.2%) developed mild fever and four patients (4.5%) required blood transfusion. Conclusion: We found supine PCNL to be an immensely convenient, time-saving practice, and with higher stone free rate compared to prone PCNL. The different techniques of supine PCNL were also useful in patients with horseshoe kidney and calyceal diverticulum which resulted in good outcomes in these patients.

Download Full-text

Supine versus prone PCNL in lower calyceal stone: Comparative study in a tertiary care center

Urologia Journal ◽

10.1177/0391560320962404 ◽

2020 ◽

pp. 039156032096240

Author(s):

Sunirmal Choudhury ◽

Paragmani Talukdar ◽

Tapan Kumar Mandal ◽

Tapas Kumar Majhi

Keyword(s):

Prone Position ◽

Care Center ◽

Tertiary Care ◽

Renal Calculus ◽

P Value ◽

Tertiary Care Center ◽

Stone Free Rate ◽

The Mean ◽

Hemoglobin Drop ◽

Free Rate

Introduction: Renal calculus disease is an age old disease of human being. PCNL (Percutaneous nephrolithotomy) stands as a gold standard treatment for large renal calculus which is traditionally being done in prone position. Objective: To evaluate the safety and efficacy of supine PCNL versus prone PCNL comparing intraoperative time, requirement of relook PCNL, post op hemoglobin drop, post operative hospital stay, post operative complication, SFR ( stone free rate). Methods and materials: It is a prospective study done in Urology department in a tertiary care center in Eastern India between October 2017 and October 2018. A total of 84 patients with lower calyceal renal stones underwent PCNL, 42 of them in supine and 42 in prone position. Lower calyceal stone, size measuring 1 to 2 cm were included in the study. Results: The mean intra operative time was 91.76 min in supine group and 85.43 min in prone group with a p value of 0.115. The mean hemoglobin drop was 1.11 g/dl and 1.18 g/dl in supine and prone position, respectively ( p value 0.75). The mean post operative hospital stay was 4.1 and 3.86 days in supine and prone group ( p value 0.58), respectively. Two patients in each group require relook PCNL. Stone free rate at 1 month was 95.23% and 90.47% ( p value 0.9), respectively in case of supine and prone group. Conclusion: Supine PCNL is feasible, comparable to prone PCNL in respect to operative parameters with relatively higher stone free rate though statistically insignificant.

Download Full-text