Comparing the effectiveness of ultrasound-guided percutaneous nephrolithotomy in the flank suspended supine, supine, and prone positions in management of renal stones in obese patients: A retrospective single center cohort study

Abstract

ObjectiveTo assess the efficacy of ultrasound-guided percutaneous nephrolithotomy (PCNL) in obese patients with renal stones by comparing different positions, namely supine, prone, and flank suspend supine positions. MethodsIn this retrospective analysis, we examined our collected database comprising 123 patients who underwent PCNL. The study focused on adult obese patients between the ages of 18 years and 70 years, with a body mass index ranging from 30 kg/m2 to 40 kg/m2 and renal stones measuring ≥2 cm in diameter. Patients were classified into three equal groups based on their PCNL positions: Group I consisted of patients undergoing flank suspended supine position PCNL; Group II included patients undergoing supine PCNL; and Group III comprised patients undergoing prone PCNL. We assessed comorbidities, conducted clinical examinations, and laboratory investigations, and recorded information about laterality and the grade of hydronephrosis. Various imaging studies, such as abdominal-pelvic ultrasound, bladder radiography, kidney, ureters, and noncontract spiral CT, were also performed. ResultsGroup I demonstrated significantly shorter operative time and hospital stay compared to both Group II and Group III (p < 0.05), while there was no significant difference between Group II and Group III. Stone-free rate was 70.7% in Group I, 61.0% in Group II, and 48.8% in Group III. The success rate was 68.3% in Group I, 51.2% in Group II, and 46.3% in Group III. ConclusionUltrasound-guided PCNL in obese patients is viable, offers real-time visualization of the access needle, and decreases radiation exposure. Flank suspended supine position seems to be as secure and efficient than other positions for these patients.