Abstract

BackgroundThe best way in the management of calyceal stone by percutaneous nephrolithotomy (PCNL) is to go directly into the desired calyx. However, in upper calyx, this direct entry may be associated with undesired complications, and through lower calyx is limited in prone PCNL. Recently, there is another option about reaching it through the lower calyx in supine position with more accessibility and better manipulation. This study aimed to evaluate the management of the upper calyceal stone by PCNL through lower calyx access in prone versus supine position.MethodsA total of 38 patients with upper calyceal stone (≥ 2 cm) were randomly divided into two groups; the first group included 18 patients managed by PCNL in the prone position, and the second group included 20 patients managed in supine position. All data of both procedures were collected and statistically analyzed to compare between both groups.ResultsThere is no statistically significant difference between groups as regards demographic and stone characters. The angle between the access to the lower calyx and access of the upper calyx was significantly wider in the supine group versus prone group (130.2° ± 23.46° vs. 89.67° ± 14.56°, respectively). The mean operative and fluoroscopy time was significantly longer in the prone group. There is no significant difference in intraoperative or postoperative morbidity. The stone-free rate was significantly higher in the supine group than the prone group (85% vs 38.9%, respectively). Also stone approachability was higher in the supine group than prone group (95% vs. 66.7%, respectively).ConclusionManagement of upper calyceal stone by PCNL through the lower calyx is safe, but it is more effective in the supine position than in prone position.

Highlights

  • The best way in the management of calyceal stone by percutaneous nephrolithotomy (PCNL) is to go directly into the desired calyx

  • The best way in the management of calyceal stone by PCNL is to go directly into the desired calyx; in upper calyx, this direct entry may be associated with undesired complication like plural or lung injury, Soliman et al Afr J Urol (2020) 26:14 hydrothorax, pneumothorax, and through lower calyx is limited in prone PCNL [4]

  • The patients were randomized into two groups by simple randomization using a closed envelopes method; the first group included 18 patients who were managed by PCNL through lower calyx in the prone position, and the second group included 20 patients managed by the same approach but in the supine position

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Summary

Introduction

The best way in the management of calyceal stone by percutaneous nephrolithotomy (PCNL) is to go directly into the desired calyx. In upper calyx, this direct entry may be associated with undesired complications, and through lower calyx is limited in prone PCNL. There is another option about reaching it through the lower calyx in supine position with more accessibility and better manipulation. The best way in the management of calyceal stone by PCNL is to go directly into the desired calyx; in upper calyx, this direct entry may be associated with undesired complication like plural or lung injury, Soliman et al Afr J Urol (2020) 26:14 hydrothorax, pneumothorax, and through lower calyx is limited in prone PCNL [4]. We compared between supine and prone PCNL in the management of upper calyceal stone through lower calyx access

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