Our initial experience in supine percutaneous nephrolithotomy

Abstract

Background: Percutaneous nephrolithotomy (PCNL) is a routine procedure for removal of kidney stones. We are doing this procedure in a prone position due to traditional training, but now, we have started doing PCNL in supine position also in IGIMS, Patna. Supine position is used when there is anesthesia-related contraindication for prone position, access to the ureter and pelvicalyceal system (PCS) is needed simultaneously, and in patients where only lower or middle calyceal puncture is needed to clear the stone.Materials and Methods: We have selected five patients with different stone characters to start with. All patients had undergone standard evaluation before the procedure. Standard consent for doing PCNL was obtained. We have used the usual instruments as used in routine prone PCNL cases. Use of nephrostomy tube (NT) or double-J (DJ) stent was decided at the end of the procedure depending on bleeding, residual fragments, injury to PCS, and extravasation of fluid. NT was removed after 48 h if given and DJ stents were removed after 4 weeks.Results: Three patients were male and two were female, aged 22–55 years. The body mass index range was 19.6–24.6. Stone clearance was achieved to 100% extent in every case as seen on post fluoroscopic image. All procedures were uneventful. One patient had both ureteric stone and renal stone and we did ureteroscopy (URS) and PCNL simultaneously to clear the stone. In one case of upper ureteric stone, we started with ureteroscopic lithotripsy but after retropulsion stone migrated to PCS, then in the same position, we did PCNL to clear that stone.Conclusion: PCNL is a standard procedure for renal stone using either supine or prone position. We should be accustomed to do PCNL in supine also and can utilize this position for doing PCNL. This practice will be extremely useful in patients who cannot be operated in prone position at all due to anesthesia region, due to spinal/bony deformity, or where both URS and PCNL are needed simultaneously.