Percutaneous Nephrolithotomy In Supine Position Research Articles

Comparison of standard percutaneous nephrolithotomy and total tubeless percutaneous nephrolithotomy in the supine position.

To compare the efficacy, safety and advantages of the total tubeless (TT) percutaneous nephrolithotomy (PCNL) and standard PCNL in the supine position. This study was carried out at İzmir Tepecik Health Application and Research Center. A total of 87 patients were examined. Forty-three patients who underwent TT procedure were defined as Group 1, and 44 patients who underwent standard procedure with a nephrostomy tube were defined as Group 2. Two techniques were evaluated with demographic data and outcome parameters. Univariate regression analyses were performed in these data sets for the parameters that predicted the TT procedure. The demographic data of the groups and all characteristics of the stones were similar. When the results were examined, the stone-free rates detected by non-contrast computed tomography (CT) in the postoperative 1st month were similar between the groups. Complication rates and secondary intervention rates were similar. Operation and fluoroscopy times were shorter in group 1, which were not statistically significant. Postoperative hemoglobin decreased, and creatinine values were similar. In Group 1, mean postoperative visual analog scale (VAS) scores and the percentage of VAS reporting > 5 points for pain level measurement were lower and statistically significant. In the univariate analysis of the factors predicting the TT procedure, no significant results were found in any parameter. Performing TT PCNL in the supine position in selected patients reduces postoperative pain without affecting the complication rates as in prone PCNL. Our study is the first to compare TT and standard PCNL in supine position.

Supine mini percutaneous nephrolithotomy in horseshoe kidney.

The percutaneous nephrolithotomy (PCNL) in Horseshoe kidneys (HSK) is usually performed in the prone position, allowing entry through the upper pole and providing good access to the collecting system. However, in patients with normal kidney anatomy, the supine position is reliable and safe in most cases, but it is unknown whether the supine position is adequate in patients with HSK. The purpose of this study was to describe the results of PCNL in HSK in three different surgical institutions and to evaluate the impact of supine position during surgery, comparing pre-operative and post-operative data, complications, and stone status after surgery. Between 2017 and 2022, a total of 10 patients underwent percutaneous renal surgery for stone disease in HSK. All patients were evaluated pre- and post- operatively with non-contrast CT. we evaluated patients (age and gender), stones characteristics (size, number, side, site and density ), and outcomes. The change in haemoglobin, hematocrit, creatinine and eGFr were assessed between the most recent preoperative period and the first postoperative day. Procedure success was defined as stone-free or presence of ≤4 mm fragments (Clinically Insignificant residual Fragments - CIrF). Complications were registered and classified according to Clavien-dindo Grading System, during the 30 - day postoperative period and Clavien scores ≥ 3 were considered as major complications. Statistical analysis was performed using "r 4.2.1" software, with a 5% significance level. we also compared pre-operative and post-operative data using "wilcoxon signedrank test". No statistical difference was observed between preoperative and post-operative renal function data. At one post operative day CT scan, an overall success rate of 100% was registered. 9/10 patients were completely free from urolithiasis (stone-free rate: 90%), while 1/10 patients had ≤4 mm residual stone fragments (CIrF rate: 10%). No cases of intraoperative complications were registered. Post-operative complications were reported in 1/10 patients. A patient developed urosepsis (defined as SIrS with clinical signs of bacterial infections involving urogenital organs - Clavien-dindo Grade II) after procedure, and was treated with intravenous antibiotic therapy successfully. Conclusions: This study shows that in patients with HSK mini- PCNL in supine position allows to achieve good stone free rate with a very low morbidity. According to our series, the described technique for PCNL in HSK should be an option. Nevertheless these results must be confirmed by further studies.

Percutaneous nephrolithotomy in supine position with less than 24-hour hospital stay; a single-center experience

ABSTRACT Objectives To report our initial experience of day care percutaneous nephrolithotomy (PCNL) with early hospital discharge within less than 24 hours of the procedure. Patients and Methods The files of patients treated with PCNL between 1st January 2020 till 31st December 2022 were retrospectively reviewed. Day care PCNL was defined as the discharge of patients either on the same day or within 24 hours after surgery. Patient age, ASA score, body mass index, stone diameter, laterality, stone burden, Hounsfield unit, and Guy’s score were analyzed. Operative time, size of the access tract, method of lithotripsy, estimated blood loss, and length of hospital stay were also recorded. Postoperative complications were stratified according to the Dindo-Clavien classification. The primary outcome was to evaluate the feasibility and safety of early discharge within 24 hours after PCNL compared to the in-patients who were kept in hospital for at least 2 days after surgery. Results A total of 85 patients underwent PCNL at our center of whom 36 patients were discharged within 24 hours (day care PCNL) of the procedure and 49 patients were kept for at least 2 days (in-patient PCNL). In the day care group, median stone burden was 465 mm2 (360-980) and 18 patients (50%) had Guy’s stone score ≥ III. The median tract size was 24 (13-30) and endoscopic combined intrarenal surgery (ECIRS) was performed in 7 cases in the day care group. Tubeless PCNL was carried out in 88.8% of the day care surgery group compared to 37.5% in the in-patient group (p < 0.0001). The postoperative complication rate was comparable between both groups (13.8% vs 22.4% for day care vs in-patient group, respectively, p = 0.08). Conclusions Day care PCNL is feasible and safe for selected patients including those having large stone burden without increasing the risk of complications or readmission rate.

Supine Percutaneous Nephrolithotomy in A High-Volume Center: First 60 Cases

Aim: To present the first 60 supine percutaneous nephrolithotomy (PCNL) surgeries performed in our clinic with regard to the results and reliability of this surgery. Material and Methods: A retrospective study carried out on 40 patients who had undergone PCNL in supine position due to the kidney stone between September 2021 and May 2022. The following parameters were studied: Demographic characteristics, stone size and HU index, operation time and postoperative complications. Results: Patient’s mean age was 46,95, the oldest one was 90 years old, and 13 of them were female. Two of the patients had solitary kidney and 15 of them had previous surgery for kidney stone. 10 patients had this surgery under spinal anesthesia. Mean stone surface area and Hounsfield Unit were 595,4 mm2 and 916.6, respectively. In 3 cases, endoscopic combined intrarenal surgery was performed. Mean operation time was 63,75 minutes and scopy time was 16.5 seconds. 27 patient had totally tubeless procedure and 30 patient had tubeless surgery. None of the patient was required to blood transfusion or any other approach related to bleeding. Only two patient had fever and needed IV antibiotics. Stone free rate was 95 % in one session. Discussion: Supine PCNL surgery is a feasible surgery with low complication rate and high stone-free rate. It is easier to switch to the supine position in clinics where this surgery is performed intensively in the prone position. It should become more widespread especially in terms of the advantages it offers compared to prone PCNL.

Supine Versus Prone Percutaneous Nephrolithotomy : An Early Experience

Background : Percutaneous Nephrolithotomy (PCNL) is a minimally invasive procedure and the gold standard for kidney stone larger than 2cm. Since it was first introduced PCNL has been carried out in the prone position. In 1987, Valdivia Uria became the first to introduce PCNL in supine position. Since then, many researchers have compared the superiority of supine of PCNL with traditional prone PCNL. We aimed to compare the surgical outcomes of supine versus prone PCNL in private hospital.&#x0D; Materials and methods: This study was a retrospective study conducted in Chattagram Metropolitan Hospital from January 2000 to February 2021. Total 52 patients underwent PCNL, in which 26 were performed in supine position and 26 performed using prone position. All data of both procedures were collected and statistically analyzed to compare between both groups.&#x0D; Results: In demographic characteristics of both groups male was predominate (69.2 vs 57.7). Both the groups were similar in terms of stone characteristics. There was no significant statistical difference in mean operative time ( 61.34 min vs 80.58min) blood transfusion ( 46.2% vs 53.8) stone clearance (96.2% vs 100%) and hospital stay ( 1-2 day vs 1-2). No major complications were observed.&#x0D; Conclusion: Although there was no significant difference of outcomes between two groups, PCNL in supine position is safe and it offers potential advantages of better ureteral access, patient handling, simultaneous retrograde and antegrade access, dependent track, easier air way control by anaesthesiologist.&#x0D; IAHS Medical Journal Vol 4(2), June 2021; 38-42

OUTCOME ANALYSIS OF PERCUTANEOUS NEPHROLITHOTOMY IN SUPINE POSITION

Supine PCNL (Percutaneous Nephrolithotomy) is an Alternative to traditional prone positioning. Benets of the supine position include easy access to the airway and Optimization of cardiopulmonary function in patients. This is a prospective study which analyzes the outcome of percutaneous nephrolithotomy in supine position. There were totally 50 patients included in the study. 27 were male and 23 female patients. Mean age was 43 years, ranging from 18 to 70 years. Right side stones seen in 60% of cases ( 30/50). Average stone size was 2.6cm ranging from 1.8 to 6cm. Average operating time were 63.5 minutes and uroscopy 18.9 minutes (5 to 35 minutes). Clearance rate in our study were pretty good with 90% (45 out of 50 cases). Five patients required secondary procedures and ve had complications in form of sepsis and bleeding requiring blood transfusion. There were no visceral injury or srtula. Thus Supine PCNL has several potential advantages with successful technical feasibility and can be used to treat all stone sizes especially very effective in high risk patients for anesthesia. There is no added risk in this technique, and the stone clearance and complication rates are comparable to standard prone PCNL

Percutaneous Nephrolithotomy in Supine versus Prone Position in Tertiary Hospital in Mysore: A Prospective Cohort Study

Introduction: Percutaneous Nephrolithotomy (PCNL) is a procedure of choice for large renal calculi. It is a common urological procedure. PCNL can be performed in various positions. Aim: To determine the surgical outcomes in patients undergoing PCNL in supine and prone positions. Materials and Methods: A cohort study was conducted on patients with renal and upper ureteral stones who underwent PCNL in either prone or supine position between August 2019 to August 2020 at Urology Department, JSS Hospital, Mysuru. Supine PCNL was done in the flank Free Oblique Supine Modified Lithotomy (FOSML) position. All the procedures were performed under fluoroscopy guidance. Surgical outcomes including operative time, length of hospital stay, Stone Free Rate (SFR), radiation dose, and postoperative complications were evaluated. The collected data was tabulated and frequency (n) and percentage (%) analysis was performed. The Chi-square test was used to find the level of significance. Results: A total of 70 patients were included in the study and out of which 35 patients were in the supine (46.37±14.73 years, 28 males and 7 females) and 35 patients (47.54±12.45 years, 23 males and 12 females) were in the prone PCNL groups. Statistically significant difference was observed in the mean operating time in the supine and prone PCNL groups (81.43 vs 127.71 minutes; p-value=0.001), with a higher stone-free rate (94.29% vs 91.43%; p-value=0.643) observed in the supine PCNL group. One patient in supine group had postoperative sepsis and one patient in prone group had bleeding requiring transfusion. The Visual Analog Scale (VAS) score in supine PCNL was (5.08±0.32) less than in prone group (8.03±0.40) (p-value &lt;0.001). Conclusion: PCNL in the supine position compared with the prone position demonstrates significantly lower operative time with similar SFR and lower VAS score.

Our initial experience in supine percutaneous nephrolithotomy

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.

Supine percutaneous nephrolithotomy in a patient with a history of previous spinal surgeries

Patients with abnormal body habitus because of spinal deformities and patients having undergone previous spinal surgeries present a challenge during surgical, anesthesiologic, and technical procedures. In these patients, management of urolithiasis may be difficult because of anatomic variations and respiratory dysfunction, stone size, spinal deformities, or risk of spinal injuries. Percutaneous nephrolithotomy (PCNL) as monotherapy has advantages in removing large stones and achieving excellent results with minimal morbidity. PCNL in supine position has several advantages attached to it, which include improvement in anesthetic management, decreased intrarenal pressures, decreased radiation exposure and improved ergonomics of fluoroscopy, improvements in patient positioning, and shorter operative time. We report a case of supine PCNL in a patient who was operated previously on the cervical and lumbar spine.

Supine versus prone position in percutaneous nephrolithotomy: a systematic review and meta-analysis.

Background: The decision for using supine or prone position in percutaneous nephrolithotomy (PCNL) is still debatable. The aim of this study is to compare the efficacy and safety profile of the supine and prone position when performing PCNL. Methods: A systematic electronic search was performed using the database from MEDLINE, Cochrane library and Google Scholar from January 2009 to November 2019. The outcomes assessed were stone free rate, major complication rate, length of hospital stay and mean operation time. Results: A total of 11 articles were included in qualitative and quantitative analysis. The efficacy of PCNL in supine position as determined by stone free rate is significantly lower than in prone position (OR: 0.74; 95% CI: 0.66 - 0.83; p<0.00001), However, major complication rate is also lower in the supine group compared with the prone group (OR: 0.70; 95% CI: 0.51 - 0.96; p=0.03). There is no statistically significant difference in the length of hospital stay and mean operation time between both groups. Conclusion: Prone position leads to a higher stone free rate, but also a higher rate of major complication. Thus, the decision of using which position during PCNL should be based on the surgeon's experience and clinical aspects of the patients.

Supine versus prone position in percutaneous nephrolithotomy: a systematic review and meta-analysis

Background: The decision for using supine or prone position in percutaneous nephrolithotomy (PCNL) is still debatable. The aim of this study is to compare the efficacy and safety profile of the supine and prone position when performing PCNL. Methods: A systematic electronic search was performed using the database from MEDLINE, Cochrane library and Google Scholar from January 2009 to November 2019. The outcomes assessed were stone free rate, major complication rate, length of hospital stay and mean operation time. Results: A total of 11 articles were included in qualitative and quantitative analysis. The efficacy of PCNL in supine position as determined by stone free rate is significantly lower than in prone position (OR: 0.74; 95% CI: 0.66 – 0.83; p&lt;0.00001), However, major complication rate is also lower in the supine group compared with the prone group (OR: 0.70; 95% CI: 0.51 – 0.96; p=0.03). There is no statistically significant difference in the length of hospital stay and mean operation time between both groups. Conclusion: Prone position leads to a higher stone free rate, but also a higher rate of major complication. Thus, the decision of using which position during PCNL should be based on the surgeon’s experience and clinical aspects of the patients.

Supine versus prone position in percutaneous nephrolithotomy: a systematic review and meta-analysis.

Background: The decision for using supine or prone position in percutaneous nephrolithotomy (PCNL) is still debatable. The aim of this study is to compare the efficacy and safety profile of the supine and prone position when performing PCNL. Methods: A systematic electronic search was performed using the database from MEDLINE, Cochrane library and Google Scholar from January 2009 to November 2019. The outcomes assessed were stone free rate, major complication rate, length of hospital stay and mean operation time. Results: A total of 11 articles were included in qualitative and quantitative analysis. The efficacy of PCNL in supine position as determined by stone free rate is significantly lower than in prone position (OR: 0.74; 95% CI: 0.66 - 0.83; p<0.00001), However, major complication rate is also lower in the supine group compared with the prone group (OR: 0.70; 95% CI: 0.51 - 0.96; p=0.03). There is no statistically significant difference in the length of hospital stay and mean operation time between both groups. Conclusion: Prone position leads to a higher stone free rate, but also a higher rate of major complication. Thus, the decision of using which position during PCNL should be based on the surgeon's experience and clinical aspects of the patients.

Total tubeless ultra-mini supine percutaneous nephrolithotomy: A feasibility study.

The ultra-mini percutaneous nephrolithotomy (PCNL) for treating low-volume renal nephrolithiasis is being used as an alternative modality to the conventional PCNL. However its use in the supine position has been scarcely reported. Patients who underwent ultra-mini PCNL in the supine position within the time frame of January 2017 to July 2017 were studied. All these patients had this as their first-line treatment. The patients had calculus limited to either a single calyx or just extending to the pelvis and the stone size was less than 2 cm in its maximal dimension. An 8.5 Fr operating nephroscope was used. The patients were positioned in the Galdakao modified Valdivia supine position. The stones were fragmented using Holmium-YAG laser. Various surgical outcomes including duration of the surgery, stone-free rate and any subsequent complications-if any-were analyzed. The study includes a series of 14 patients with 15 renal units (one patient treated with bilateral renal stone disease). The mean age of the patients was 39.07 years and body mass index was 25.5 kg/m2. Intrarenal stone location was as follows: lower calyx, n=8; middle calyx, n=3, upper calyx, n=1, and pelvis, n=3. Median operative time was 52.66 min (range: 40-70) and the stone-free rate was 93.3%. Only one patient had residual fragments and needed subsequent extracorporeal shock wave lithotripsy. Ultra-mini PCNL in supine position with a complete tubeless approach for renal stone disease is a safe method for treating low-volume disease. Studies with a larger cohort may be required to finally validate this technique.

Percutaneous Nephrolithotomy in Supine Position: A Single Center Experience

Percutaneous Nephrolithotomy in Supine Position: A Single Center Experience

E43 Percutaneous nephrolithotomy in supine position and its different accesses: Is the upper calix a good option?

E43 Percutaneous nephrolithotomy in supine position and its different accesses: Is the upper calix a good option?

MP30-16 PROGNOSTIC FACTORS OF POSTOPERATIVE COMPLICATIONS IN PERCUTANEOUS NEPHROLITHOTOMY

You have accessJournal of UrologyStone Disease: Surgical Therapy III1 Apr 2015MP30-16 PROGNOSTIC FACTORS OF POSTOPERATIVE COMPLICATIONS IN PERCUTANEOUS NEPHROLITHOTOMY Fabio C. Vicentini, Carlos H. Watanabe-Silva, Vinicius Meneguete, Rodrigo Perrela, Claudio B. Murta, and Joaquim F.A. Claro Fabio C. VicentiniFabio C. Vicentini More articles by this author , Carlos H. Watanabe-SilvaCarlos H. Watanabe-Silva More articles by this author , Vinicius MenegueteVinicius Meneguete More articles by this author , Rodrigo PerrelaRodrigo Perrela More articles by this author , Claudio B. MurtaClaudio B. Murta More articles by this author , and Joaquim F.A. ClaroJoaquim F.A. Claro More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.598AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for large kidney stones but there are concerns regarding the complication rates. Our aim is to evaluate the peri-operatory factors associated with complications after PCNL. METHODS We performed a retrospective chart review of a prospective database of patients who underwent PCNL between July 2011 and July 2014. Preoperative and postoperative factors, such as age, body mass index (BMI), surgical risk, stone complexity (Guy's Stone Score - GSS), access calyx, patient positioning, blood transfusion and surgical time were evaluated as predictors of complications. All complications were graded according to the Clavien Classification. The tests used in the univariate analyzes were chi-square and Fisher Exact test for categorical measures and the Student t test for continuous measures. For the multivariate analysis we used logistic regression. RESULTS A total of 468 patients were included in the study and 517 PCNL were performed. The mean age was 48.3±12.8 years, mean BMI of 27.3±5.0 and 57.8% were female. Of these, 82% underwent to PCNL in supine position and 18% in the prone position. According to GGS, 24.8% were GGS1, 28.6% GSS2, 33.8% GSS3 and GSS4 12.8%. Most punctures were on lower and middle calyx (65.8% and 24.8% respectively) and 9.3% of the punctures were supracostal. Mean surgical time 114.6±52.78 min. The success rate (fragments ≤4mm) at POD 1 on CT scan was 55.1% The overall complication rate was 18.7%. According to the modified Clavien Classification System, 5.3% Clavien I, 6.7% Clavien II, 2.0% Clavien IIIa, 2.3% Clavien IIIB, 1.6% Clavien IVa, 0.4% Clavien IVB and 0.4% Clavien V. The transfusion rate was 6.0%. On univariate analysis, the number of accesses, supracostal puncture, upper calyx puncture and higher GSS were predictors of Clavien≥3 (major complications). On multivariate analysis, GSS and upper calyx puncture were the only predictors statistically significant for post-operative complications Clavien ≥3. GSS III and IV increased risk for high grade Clavien compared to GSS I and II (OR 2.52; CI95% 1.21-5.52) and also upper pole access compared to inferior pole access (OR 4.85; CI95%1.46-13.92). Moreover, prone position (OR 2.53; CI95%1.0-6.08), number of punctures (OR 6.11 CI95%1.58-24.04) and high GSS (OR3.01 CI1.19-8.6) were associated with blood transfusions on multivariate analysis. CONCLUSIONS The number of punctures, supracostal access, high GSS and prone position were factors associated with major complications and blood transfusions after PCNL. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e353 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fabio C. Vicentini More articles by this author Carlos H. Watanabe-Silva More articles by this author Vinicius Meneguete More articles by this author Rodrigo Perrela More articles by this author Claudio B. Murta More articles by this author Joaquim F.A. Claro More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

A Prospective Comparative Study Between Minimally Invasive Percutaneous Nephrolithotomy in Supine Position and Flexible Ureteroscopy in the Management of Single Large Stone in the Proximal Ureter

To investigate the difference and relative advantages between minimally invasive percutaneous nephrolithotomy (MPCNL) in supine position and flexible ureteroscopy (FURS) in the management of surgically indicated single large stone in the proximal ureter. Patients with single large stone in the proximal ureter with slight to moderate hydronephrosis were prospectively selected and assigned into groups of MPCNL and FURS on the basis of the patient's choice. Demographic data, operative duration, postoperative hospital stay, complication rate, and stone-free rate were recorded and compared. From October 2010 to May 2012, 76 such patients were consecutively included into the study. No significant difference was found in preoperative demographics, including age, sex, and severity of hydronephrosis. Stone size was 15.6 ± 2.5 and 14.9 ± 2.3 mm (P = .349), operative duration 49.3 ± 11.7 and 67.2 ± 17.3 minutes (P <.001), postoperative hospital stay 4.2 ± 1.1 and 1.8 ± 0.8 days (P <.001), stone-free rate (residual ≤ 3 mm) 93.7% and 84.1% (P = .198), and complication rate over grade II (modified Clavien system) 12.5% and 6.8% (P = .398) in MPCNL and FURS groups respectively. Both MPCNL in supine position and FURS are effective and safe surgical options for patients with single large stone in the proximal ureter, when indicated. FURS is associated with faster recovery and less invasiveness than MPCNL in supine position.

A comparative study of percutaneous nephrolithotomy in supine position and endoscopic combined intrarenal surgery with flexible instrument

ObjectiveTo compare the results obtained in percutaneous nephrolithotomy after introduction of flexible ureteroscopy/nephroscopy (endoscopic combined intrarenal surgery – ECIRS) with nephrolitomies with only rigid nephroscopy (standard percutaneous nephrolithotomy; sPCNL). Materials and methodsA retrospective study of 171 sPCNL in Galdakao position performed between January 2005 and December 2011 was conducted. We compared the results obtained in those procedures in which endoscopic combined intrarenal surgery (ECIRS) was performed with those in which only the rigid nephroscopy (sPCNL) was used. Specific and global success, percentage of lithiasic load eliminated, days of hospital stay and complications derived were calculated. We defined success by complete absence of lithiasis or residual presence of <5mm. We differentiated specific success, that only achieved with percutaneous surgery, from global success, or that achieved after a second line of treatment. ResultsIn 73 procedures (42.4%) ECIRS was performed with flexible endoscopy while in 98 (57.6%) it was done with sPCNL. Both groups were comparable in regards to demographic parameters and characteristics of the lithiasis. The success rates in the first procedure and global success were superior for the ECIRS group (75.3% vs. 40.8% and 93.1% vs. 74.5%), the differences being statistically significant (P<.05). No statistically significant differences were found in regards to the complications (28.8% vs. 28.3%; P=.86) or days of hospital stay (4.5 vs. 5.0; P=.18). ConclusionsUse of the flexible ureteroscopy/nephroscopy in sPCNL (ECIRS) improves the success rates and elimination of lithiasic load, making it possible to perform the surgery with a single access in most of the cases.

Learning of percutaneous nephrolithotomy in supine position. An observational multicenter study

ObjectiveTo prospectively study the post-operative results and complications of percutaneous nephrolithotomy (PNL) in supine position to assess difficulty of learning it and how experience affects the results. To establish a relative comparison with the data published in the literature on the prone position. Material and methodsA prospective observational multicenter study on PNL in Valdivia position or in its Galdakao variant was performed. Demographic variables and specific variables related to the lithiasis were collected. Technical aspects, surgery time, success rate and complications according to the Clavien–Dindo classifications were assessed. ResultsA total of 335 PNL in supine position conducted in 13 Spanish centers were registered from September 2008 to June 2011. The man:woman ratio was 1:1.28 and mean age 51.3±14.5 years. 211 (63%) cases were performed by urologists with experience in ≥50 cases and 124 (37%) by urologists with less experience. Mean operation time was 113.3±46.4min, 106.6±38.2 for the experienced ones vs. 124.9±56.2 in the novice ones (p<0.002). No difference was detected in the mean size of the lithiasis. However, in the experienced group, there was a greater proportion of coraliform cases and multiple lithiasis than in the novice group (p<0.001). Success rate was evaluated, as total absence of lithiasic residuals was 69.6%, without differences between groups (68.2 vs. 71.8%). 102 (30.6%) patients had residual lithiasis and 60 (17,9%) required complementary treatment. Relative global success rate was 82.1% and complications rate 25.4%, without detecting differences between groups. However, the novel group had more major complications (p>0.001). ConclusionThe PNL in supine position is obtaining rapid and consolidated diffusion in our setting and its effectiveness and safety seem to be equivalent to that described in the literature for PNL in prone position. It is possible to obtain good results with a modest learning curve. The rate of greater complications associated to the procedure decreases with experience.

El aprendizaje de la nefrolitectomía percutánea en posición supina. Estudio observacional multicéntrico

ObjectiveTo prospectively study the post-operative results and complications of percutaneous nephrolithotomy (PNL) in supine position to assess difficulty of learning it and how experience affects the results. To establish a relative comparison with the data published in the literature on the prone position. Material and methodsA prospective observational multicenter study on PNL in Valdivia position or in its Galdakao variant was performed. Demographic variables and specific variables related to the lithiasis were collected. Technical aspects, surgery time, success rate and complications according to the Clavien-Dindo classifications were assessed. ResultsA total of 335 PNL in supine position conducted in 13 Spanish centers were registered from September 2008 to June 2011. The man:woman ratio was 1:1.28 and mean age 51.3+14.5 years. 211 (63%) cases were performed by urologists with experience in >50 cases and 124 (37%) by urologists with less experience. Mean operation time was 113.3±46.4min, 106.6±38.2 for the experienced ones vs. 124.9±56.2 in the novice ones (P<.002). No difference was detected in the mean size of the lithiasis. However, in the experienced group, there was a greater proportion of coraliform cases and multiple lithiasis than in the novice group (P<.001). Success rate evaluated as total absence of lithiasic residuals was 69.6%, without differences between groups (68.2 vs. 71.8%). In 102 (30.6%) patient had residual lithiasis and 60 (17,9%) required complementary treatment. Relative global success rate was 82.1% and complications rate 25.4%, without detecting differences between groups. However, the novel group had more major complications (P>.001). ConclusionThe PNL in supine position is obtaining rapid and consolidated diffusion in our setting and its effectiveness and safety seems to be equivalent to that described in the literature for PNL in prone position. It is possible to obtain good results with a modest learning curve. The rate of greater complications associated to the procedure decreases with experience.