1454 VISCERAL ORGAN-TO-PERCUTANEOUS TRACT DISTANCE IS SHORTER WHEN PATIENTS ARE PLACED IN PRONE POSITION ON BOLSTERS COMPARED TO SUPINE POSITION

Abstract

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopic or Percutaneous Stone Removal I1 Apr 20101454 VISCERAL ORGAN-TO-PERCUTANEOUS TRACT DISTANCE IS SHORTER WHEN PATIENTS ARE PLACED IN PRONE POSITION ON BOLSTERS COMPARED TO SUPINE POSITION Raed A. Azhar, Konrad M. Szymanski, Emmanuelle Lemercier, David Valenti, Sero Andonian, and Maurice Anidjar Raed A. AzharRaed A. Azhar More articles by this author , Konrad M. SzymanskiKonrad M. Szymanski More articles by this author , Emmanuelle LemercierEmmanuelle Lemercier More articles by this author , David ValentiDavid Valenti More articles by this author , Sero AndonianSero Andonian More articles by this author , and Maurice AnidjarMaurice Anidjar More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1168AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Percutaneous nephrolithomy (PCNL) in the prone position is associated with a 0.1% risk of colon injury, yet there have not been any reported cases of colon injury with supine PCNL. Therefore, the aim of the present study was to prospectively compare computed tomography (CT) scans of patients performed in both supine and prone positions using bolsters. METHODS Sixteen consecutive patients (mean age 55, 12 males) with renal calculi (3 bilateral) in 19 renal units presenting for PCNL underwent preoperative supine (without bolsters) and prone (with bolsters) non-infused CT scans. Axial images through lower pole calyces containing stones requiring percutaneous access were then analyzed. Percutaneous access was planned based on both supine and prone CT scans. Skin-to-stone distance (cm), angle of the percutaneous tract to the perpendicular (degrees) and visceral organ-to-tract distance (cm) were measured. Wilcoxon signed rank test were used to compare the two groups. The Kruskal-Wallis test was used to assess if the distance of visceral organ-to-percutaneous access tract differed when corrected by skin-to-stone distance. RESULTS Visceral organ-to-tract distance decreased from 3.5cm in the supine position to 2.8cm (p=0.045) in the prone position. In 3 renal units, visceral organ-to-tract distance in the prone position was less than 0.4cm. On prone positioning, skin-to-stone distance decreased from 9.0 to 7.6cm (p=0.0001) and the tract angle increased from 35 to 40 degrees (p=0.02). Nineteen renal units were then divided into two groups according to the median skin-to-stone distance. There was a greater difference in visceral organ-to-tract distance between the two groups when patients were in the prone position (1.7cm vs. 2.7cm, although this was not statistically significant p=0.36). CONCLUSIONS Pre-operative planning CT scans should be performed in the prone position with bolsters to better assessment of organ-to-tract distance when prone PCNL is contemplated. Montreal, Canada© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e560 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Raed A. Azhar More articles by this author Konrad M. Szymanski More articles by this author Emmanuelle Lemercier More articles by this author David Valenti More articles by this author Sero Andonian More articles by this author Maurice Anidjar More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...