Prone Percutaneous Nephrolithotomy Research Articles

Comparison of Combined Guidance of Fluoroscopy and Ultrasonography in Total Tubeless Percutaneous Nephrolithotomy with the Standard Method: A Randomized Clinical Trial.

Utilizing the combination of fluoroscopy and ultrasonography during Percutaneous Nephrolithotomy (PCNL) to minimize radiation exposure. In this randomized clinical trial, 118 patients with urinary stones who were candidates for PCNL surgery in the prone position were selected and divided into two groups (with an allocation ratio of 1:1). Cases were grouped according to whether ultrasonography was used for renal tract dilation and Amplatz sheath placement. The number of attempts to establish proper renal access, the time interval between access to the targeted calyx and nephroscope entrance, and the Clavien-Dindo score were collected. The mean age of all patients was 46.12 ± 11.28 (45.6 ± 11.2 in the total fluoroscopy group and 46.5 ± 11.4 in the combined group) years (20-66). The intergroup differences in the baseline features were not significant. The mean duration of fluoroscopy time was significantly reduced in the combined guidance group (36.22 ± 10.73 vs. 23.05±8.94 seconds, (P-value = 0.001). Moreover, the difference in the distribution of Amplatz location on the nephroscopy time was meaningful (P-value = 0.016). However, intergroup differences in the number of attempts to successful puncture, length of hospitalization, recovery time, and postoperative complications, including gross hematuria duration, blood loss volume, pack cells requirement, pain score immediately and 6 hours after the surgery, and Clavien-Dindo score were not meaningful. It can be concluded that the use of ultrasound with X-ray in prone PCNL compared to the use of X-rays alone can significantly reduce the duration of radiation without increasing the risk of intra-operative and postoperative detrimental events.

Propensity Score-Matched Analysis of Perioperative Outcomes of Supine versus Prone Percutaneous Nephrolithotomy.

Objective: To compare the perioperative outcomes of supine and prone percutaneous nephrolithotomy (PCNL). Methods: A retrospective search of a tertiary medical center database yielded 517 patients who underwent supine (n = 91) or prone (n = 426) PCNL between September 2015 and July 2020. Data on demographics, baseline clinical parameters, and stone burden were included as predictors in a logistic regression model, generating a set of propensity scores. Seventy patients after supine PCNL were propensity score-matched 1:1 with patients after prone PCNL and compared for operative time, perioperative complications, system complexity, and stone-free rate. Results: We found that the operative time was significantly shorter in the supine PCNL group than in the prone PCNL group (85.5 ± 25.2 min vs. 96.4 ± 25.8 min, respectively; p = 0.012). The majority of both groups had low-grade (I-II) complexity systems (85.6% and 88.6%, respectively), with no significant difference among all grade groups (p = 0.749). There were no significant differences between the supine and prone PCNL groups in terms of the overall perioperative complication rate (8.6% vs. 4.3%, respectively; p = 0.301) or stone-free rate (74.3 vs. 65.7%, respectively; p = 0.356), while the rate of blood transfusion was significantly higher in the supine group (p = 0.023). Conclusions: In our study, we used propensity score matching to compare patients who underwent PCNL in the supine or prone position, adjusting for selection bias. Supine PCNL was associated with a shorter operative time but a higher blood transfusion rate, with no differences in the overall complication and stone-free rates.

Prone vs supine percutaneous nephrolithotomy: does position affect renal pelvic pressures?

The purpose of this study was to measure and compare renal pelvic pressure (RPP) between prone and supine percutaneous nephrolithotomy (PCNL) in a benchtop model. Six identical silicone kidney models were placed into anatomically correct prone or supine torsos constructed from patient CT scans in the corresponding positions. A 30-Fr renal access sheath was placed in either the upper, middle, or lower pole calyx for both prone and supine positions. Two 9-mm BegoStones were placed in the respective calyx and RPPs were measured at baseline, irrigating with a rigid nephroscope, and irrigating with a flexible nephroscope. Five trials were conducted for each access in both prone and supine positions. The average baseline RPP in the prone position was significantly higher than the supine position (9.1 vs 2.7 mmHg; p < 0.001). Similarly, the average RPP in prone was significantly higher than supine when using both the rigid and flexible nephroscopes. When comparing RPPs for upper, middle, and lower pole access sites, there was no significant difference in pressures in either prone or supine positions (p > 0.05 for all). Overall, when combining all pressures at baseline and with irrigation, with all access sites and types of scopes, the mean RPP was significantly higher in the prone position compared to the supine position (14.0 vs 3.2 mmHg; p < 0.001). RPPs were significantly higher in the prone position compared to the supine position in all conditions tested. These differences in RPPs between prone and supine PCNL could in part explain the different clinical outcomes, including postoperative fever and stone-free rates.

Supine versus prone percutaneous nephrolithotomy in management of patient with complex renal stone diseases.

Compare the surgical outcomes, safety, stone free rate, hospital stay, and complication of prone and supine PCNL in case of complex renal stone. This is an observational study conducted in our institute, it consist of 120 patients over the period of 2 years from July 2021 to June 2023, all the patients were divided into two groups: 60 patients underwent modified supine percutaneous nephrolithotomy (PCNL) and remaining 60 patients underwent standard prone PCNL. The measured data included operative time, number of punctures, blood loss, stone-free rate, length of hospital stays, and rate of complications. The two groups were comparable in mean age, male to female ratio, number of punctures, number of tract, size of tract, residual calculi in follow up period, blood transfusion, re-do surgery, chest complication, hospital stay, and postoperative fever and pain. The mean operating time was 1.59 h in supine PCNL and 2.49 h in prone PCNL. The p value was significant (p = 0.001). By this study we observed that the supine PCNL is associated with statistically significant reduced operating time as compared to conventional prone PCNL with advantages of not putting the patient in prone position. The postoperative complications such as pain and fever were not significant when compared in both groups. We conclude our study and found that, the supine PCNL is an equally effective in treating complex renal stone as compared to prone PCNL.

Supine tubeless upper pole PCNL under spinal anaesthesia: Safety, feasibility and outcomes from a tertiary endourology centre

ABSTRACT Objective Supine Percutaneous Nephrolithotomy (PCNL) is being taken up by many urologists in recent times, but there is a tendency to shift to prone PCNL for upper pole puncture. We analyzed the safety, feasibility and outcomes of upper pole access in Supine Percutaneous Nephrolithotomy (sPCNL). Materials and methods A retrospective review of all patients undergoing sPCNL at a tertiary care center was done from January 2021 to December 2022. Data collection was done from the maintained imaging, laboratory and hospital records. All cases with complete data on upper pole access were included. Data analysis was done with Xlstat2021. Results 50 patients with upper pole access were included (64%, 32 with single access and 36%, 18 with multiple accesses). The mean stone size was 23.88 ± 9.99, mean HU was 1093 ± 232.83, and the mean operative duration was 67.92 ± 34.62. Stone clearance rate was 98.82%, with all procedures performed tubeless. The mean haemoglobin drop was 0.75 ± 0.42 gm/dl with 2 (4%) patients needing a blood transfusion. The overall complication rate was 22% with only 1 Clavien Dindo III complication (1 pleural injury and hydrothorax needing USS guided aspiration) and others being Clavien Dindo I/II complications. Conclusion Supine PCNL is a feasible and safe approach for upper pole access. While the procedure can be done tubeless, these procedures must be done in experienced endourology units.

Could pain change position choice? Comparison of pain level, analgesic requirement and hospitalization time in supine and prone percutaneous nephrolithotomy.

Investigation of how position affects postoperative pain levels and hospitalization in patients undergoing percutaneous nephrolithotomy (PNL) surgery. Between August 2019 and December 2022, a total of 156 patients who underwent prone (pPNL) and supine percutaneous nephrolithotomy (sPNL) due to kidney stones were included in the study. Demographic data, preoperative CT scans, laboratory results, transfusion rates, operation durations, complication rates, stone-free rates, analgesic use, nephrostomy removal time, hospitalization duration, fluoroscopy time, hemoglobin decrease and postoperative Visual Analog Scale (VAS) scores were evaluated for all patients. By comparing these data between the sPNL and pPNL groups, the effect of position selection in PNL on pain control, analgesic requirement, and hospitalization duration was examined. In the comparison of the pPNL and sPNL groups, there was a significant difference between the two groups in body mass index, hounsfield unit, complication rate, analgesic rate, nephrostomy remove time, hospitalization time, operation time, fluoroscopy time and VAS score (p = 0.025, p < 0.001, p = 0.012, p = 0.012, p < 0.001, p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). The shorter operation and hospitalization time in the sPNL group could be attributed to performing surgeries in a physiological position. Additionally, sPNL seems advantageous in terms of patients' pain levels, hospitalization time and VAS scores. One reason for this could be the different areas of access in sPNL and pPNL, which may correspond to different dermatome regions. Considering the low level of pain and reduced analgesic usage, sPNL appears to be advantageous.

90° Puncture Technique in Prone Percutaneous Nephrolithotomy in Pediatric Age Group

90° Puncture Technique in Prone Percutaneous Nephrolithotomy in Pediatric Age Group

Mini Percutaneous Nephrolithotomy in Ectopic Lumber Kidney: A Case Report

The chance of the development of hydronephrosis and the formation of stones is more in the ectopic kidney. Treatment of stones in ectopic kidneys is challenging for urologists due to abnormal location and rotation of the kidney and unfavourable local anatomy. We herein report a case of stone in a lumber kidney successfully managed by mini percutaneous nephrolithotomy (PCNL) in a prone position. A 55-year-old male presented with right lower abdominal pain. His CT scan of the KUB reveals the right kidney is in an ectopic location and has a hyperdense structure measuring about 15 mm in length, seen in the right renal pelvis with mild dilatation of the pelvicalyceal system. The patient underwent right-sided prone mini PCNL under the subarachnoid block (SAB), and complete stone clearance was achieved. There was no adverse event during or after surgery or post-operative blood transfusion. Bangladesh J. Urol. 2022; 25(2): 122-125

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

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.

Which position is more advantageous for percutaneous nephrolithotomy: supine or prone?

Percutaneous nephrolithotomy (PNL) can be performed in a number of different positions. Our aim was to evaluate the convenience and advantages of the supine position following the transition from the prone to the supine position. 94 patients undergoing supine PNL (Group-1) and 93 patients undergoing prone PNL (Group-2) were retrospectively reviewed and included in the study. Patients who underwent mini-PNL (mPNL) were selected from Group-1 and Group-2 and divided into Group-1A supine mPNL patients (77) and Group-2A prone mPNL patients (53). Demographic characteristics, operative data and post-operative parameters were compared between these groups. The operation time was 74.4 ± 21.9min in Group-1A and 79.2 ± 19.8min in Group-2A (p= 0.076). The median value of fluoroscopy time was 30s in Group-1A and 40s in Group-2A (p= 0.003). In Group-1A, 59 patients had no intraoperative double-J stent (DJS) insertion and 18 patients had DJS insertion, while in Group-2A, 24 patients had no DJS insertion and 29 patients had DJS insertion (p < 0.001). MPNL was performed in 81.9% of patients in the supine position and 57% in the prone position. This difference was statistically significant (p < 0.001). No significant difference was found with regard to the success rate and the complications of mPNL. Fluoroscopy time is shorter in the supine position. Moreover, the insertion rates of DJS are low. With increasing experience, we have found that our standard PNL (sPNL) rate is gradually decreasing and more mPNL is being performed.

Comparative Study of Prone Position Variations for Percutaneous Nephrolithotomy.

In this comparative study, we evaluated the results of flat prone and prone hip flexed percutaneous nephrolithotomy in terms of efficacy and safety to contribute to the optimal prone percutaneous nephrolithotomy position. Data of the patients who underwent percutaneous nephrolithotomy operations in a flat-prone or prone hip flexed positions due to renal pelvis and/or ≥2 Calix filling stones between January 2016 and January 2022 were collected retrospectively. Demographic data of the patient groups in different prone positions as well as clinical findings, stone characteristics and operative data were analyzed. The groups were also compared in terms of post-operative findings and complications. The average age and CROES scores of patients included in the study were 47.15±15.6 years and 221.76±62.49, respectively. There was no statistically significant difference between the two groups in terms of patient demographic data, stone-free status and complication rates. Operation Room Time (ORT) (min) in flat prone PCNL group was shorter in average (100.57±32.74 min vs 92.32±28.75 min, p = 0.041) and duration with nephrostomy (days) and hospitalization (days) parameters were statistically significantly shorter in prone hip flexed PCNL (respectively, p < 0.001; p = 0.005). Flat-prone PCNL provides significantly shorter ORT. However, the time with nephrostomy and hospitalization with the prone hip flexed PCNL were shorter than flat-prone position. The findings will guide the optimal prone PCNL position.

MP35-17 GEL ROLLS SUBSTANTIALLY INCREASE RADIATION DOSE IN PRONE PERCUTANEOUS NEPHROLITHOTOMY (PCNL)

You have accessJournal of UrologyCME1 Apr 2023MP35-17 GEL ROLLS SUBSTANTIALLY INCREASE RADIATION DOSE IN PRONE PERCUTANEOUS NEPHROLITHOTOMY (PCNL) Kayvon Kiani, Eric Ballon-Landa, Xavier Glover, Brett Wiesen, and Mark Sawyer Kayvon KianiKayvon Kiani More articles by this author , Eric Ballon-LandaEric Ballon-Landa More articles by this author , Xavier GloverXavier Glover More articles by this author , Brett WiesenBrett Wiesen More articles by this author , and Mark SawyerMark Sawyer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003269.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prone percutaneous nephrolithotomy (PCNL) has been associated with higher fluoroscopy doses than supine PCNL. As part of a QI project, the authors now routinely use an Artis Zeego Care+Clear™ (Siemens) floor-mounted robotic multiplanar fluoroscopy system (RMPFS) to perform ultra-low-dose (ULD) intraoperative CT scans (ICT) during treatment of large stones. Despite lower BMI (27.6 vs. 30.0) and the same protocol (5s BODY CARE), the ULD ICT dose area product (DAP) for the single prone PCNL case was 84% higher (1036 vs. 564 uGy*m2) than when performed supine (n=26). Because gel rolls were visible in coaxial imaging, we hypothesized that gel rolls directly increased radiation exposure. METHODS: Ex vivo experiments were performed with RMPFS 5 s BODY protocol coaxial imaging using a prone-positioned fluoroscopy phantom placed on a gel roll; placed on blankets of equal thickness; or directly on the table. Spins were also performed in the supine and modified supine positions; using a thin gel roll or rolled blanket. Reported DAP was compared for the groups. RESULTS: Mean DAP was 3.9 times higher when the phantom was prone on gel rolls than directly on the table; and 3.2 times higher than prone on blankets. Thus, total radiation dose increased by 287% when gel rolls were used for positioning. With blankets, the total radiation dose was 23% higher in the prone position. There was a modest 5.6% increase in DAP between prone and supine positioning. In the modified supine position the use of a thin gel roll increased the total radiation dose 3–8% compared to blankets. CONCLUSIONS: Our hypothesis was confirmed experimentally with a standardized protocol that gel rolls directly increase measured radiation dose. Surgeons should consider radiolucent materials for positioning to limit radiation exposure to patients and the surgical team. Following this observation, the authors have substituted rolled blankets for gel rolls for PCNL positioning. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e476 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kayvon Kiani More articles by this author Eric Ballon-Landa More articles by this author Xavier Glover More articles by this author Brett Wiesen More articles by this author Mark Sawyer More articles by this author Expand All Advertisement PDF downloadLoading ...

COMPARATIVE STUDY OF PERCUTANEOUS NEPHROLITHOTOMY IN SUPINE VERSUS PRONE POSITION

Prone positioning in percutaneous nephrolithotomy is more and more being replaced by supine positioning now a days for its various benefits. This is a prospective study which does Comparative study on percutaneous nephrolithotomy in supine versus prone position and their various outcomes were analysed. There were totally 100 patients included in the study with 50 patients each group (supine versus prone). 57 were male and 43 female patients. Age ranging from 18 to 70 years. Right side stones were 58 and left side was 42. Age, gender and side of stones were similar between two groups. Stone burden were 2.6cm and 2.9cm for supine and prone group respectively. But average operating time were 63.5 minutes ( 35 to 120 minutes) for supine group versus 80 minutes ( 45 to 160 minutes) for prone group. fluoroscopy time was 18.9 minutes for supine group versus 29.4 minutes for prone group. Clearance rate in our study were pretty good in both groups around 90% in both groups (90% vs 88%). five had complications in form of sepsis and bleeding requiring blood transfusion in both groups. Five in supine group and six in prone group required second procedures. Thus Supine percutaneous nephrolithotomy group had significant advantage in terms of less operative duration and less fluoroscopy time than prone percutaneous nephrolithotomy . The stone clearance and complication rates were similar in both the groups

Outcome and complications of percutaneous nephrolithotomy for renal stones – Our institutional experience

Background: Percutaneous nephrolithotomy (PCNL) is the preferred treatment of choice for renal calculi. PCNL has evolved remarkably since the eighties when it was first described. PCNL is the treatment of choice for renal stones ≥2 cm. Aims and Objectives: Our aim is to observe the various surgical outcomes of different types of PCNL. Materials and Methods: It is an observational study conducted in our institute a total of 160 pts of renal stone disease who presented to the outpatient department were included in the study. All patients underwent PCNL either in supine or prone position. The parameters such as stone free rate, body mass index (BMI), stone size, operative time, length of stay (LOS), in hospital, and complications were observed. Results: There were no significant differences in stone size between supine and prone PCNL patients. The supine group had a higher mean BMI, shorter mean surgical time, shorter mean LOS, and higher stone free rate. Prone PCNL patients had a higher rate of overall complications. Conclusion: PCNL is one of the best modalities for renal stones management, with supine and modified supine PCNL demonstrating better results in obese patients, and may be considered by all surgeons performing PCNLs.

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.

Is supine percutaneous nephrolithotomy an alternative to prone percutaneous nephrolithotomy? Our experience at a tertiary care center

Background: Majority of urologists prefer the usual prone position for percutaneous nephrolithotomy (PCNL) but due to various disadvantages of prone PCNL, several alternative positions are being used. Aims and Objectives: The aim of the study was to compare the surgical outcomes of PCNL performed using supine position with those performed in the prone position. Materials and Methods: This was a prospective and observational study. After applying inclusion criteria, 60 renal calculi patients were randomly assigned to two groups, each with 30 patients, all demographic, operative, and post-operative characteristics were recorded. Results: Out of 60 patients, 38 (63%) patients were male and 22 (37%) were female. The mean age (in years) in prone PCNL was 45.03±17 while in supine, it was 51.7±15. Forty patients had mild, 12 had moderate, and eight had gross hydronephrosis. Stone size (mm) ranged from 20 to 55 with a mean stone size of 22.5±8.8 in prone PCNL and 23.9±13.5 in supine PCNL. The mean operative time (minutes) was 65.1±27.2 in prone PCNL and 68.7±16 in supine PCNL (P=0.068). Complete stone clearance was seen in 26 (86%) patients in prone PCNL versus 25 (83%) patients in supine PCNL. Five patients in supine PCNL had Grade 1–2 complications. There were no serious complications in either group. The mean post-operative hospital stay (days) was 3.53 in prone PCNL versus 3.63 in supine PCNL, (P=0.715). Conclusion: Supine PCNL is an effective and safe procedure with similar operative time, stone-free rate, and complications to prone PCNL.

Does surgical position affect infective complications in percutaneous nephrolithotomy?

The downward orientation of the access sheath during supine percutaneous nephrolithotomy (PCNL) allows the faster evacuation of fluids and stone fragments. It theoretically can contribute to the reduction of the high intrarenal pressure-associated complications. We aimed to investigate whether there is a difference between prone and supine PCNL in terms of infective complications. This retrospective study includes 182 patients who underwent supine and prone PCNL due to kidney stones in our clinic between April 2020 and May 2022. Demographic (age, sex, body mass index, comorbidities), radiological (cumulative stone burden, stone density, number of stones, stone localization, stone laterality, presence of hydronephrosis), clinical (previous stone surgery, previous urinary tract) and perioperative (prone or supine position, surgery duration, hospitalization, success, non-infective and infective complications) data of all patients were evaluated. All patients were divided into two groups, the prone position group, and the supine position group. These two groups were compared in terms of pre and postoperative data above. Infective complications were observed in 16 (18%) patients in the prone position group and in 7 (7.5%) patients in the supine position group, and this difference was statistically significant (p = 0.034). Surgery duration (OR = 1.041; 95% CI 1.021-1.061; p < 0.001), number of stones (OR = 4.09; 95% CI 1.093-7.309; p = 0.036), previous urinary tract infection (OR = 6.272; 95% CI 1.936-9.317; p = 0.002) and prone position (OR = 4.511; 95% CI 1.265-7.087; p = 0.02) were found as independent risk factors for infective complications. Prone position was proved as an independent predictor of postoperative infectious events. Supine PCNL will be further adopted as the standard PCNL approach by a continuously growing proportion of endourologists.

Learning Curves of Flexible Ureteroscopy (275 Cases) and Prone Percutaneous Nephrolithotomy (73 Cases) in Pediatric Stones: Data from 348 Children.

Objectives: To evaluate learning curves in pediatric flexible ureteroscopy (FURS) and pediatric prone percutaneous nephrolithotomy (PCNL) by a single surgeon with experience in adult endourologic procedures. Materials and Methods: Children who were found to have nephrolithiasis and treated with PCNL or FURS from June 2014 to April 2019 were analyzed. Patient demographics, stone characteristics, stone-free rate (SFR), and complication rate (CR) were reported. Learning curves were generated to estimate the effect of a surgeon's experience on outcomes. Results: Seventy-three children underwent PCNL on 86 sides in 77 operations and 275 children underwent FURS on 320 sides in 288 operations. The SFRs were 88.1% (282/320) for FURS procedures and 89.5% (77/86) for PCNL procedures. CRs were 19.8% (57/288) and 35.1% (27/77), respectively. Learning curves showed that the SFRs of the two procedures increased with the accumulation of cases. There was an apparent improvement of SFR for PCNL procedures after ∼60 surgeries. A favorable SFR of FURS could be achieved at the start of learning. No apparently decreased CRs were observed for either PCNL or FURS. Conclusions: Both PCNL and FURS could achieve satisfactory SFRs and accepted CRs in pediatric stones. Increased surgical experience was associated with improved SFRs of both PCNL and FURS procedures, and the surgeon's experience of adult FURS translating to that of pediatric FURS was better than adult PCNL translating to pediatric PCNL. A surgeon needs ∼60 cases of PCNL to achieve competence. For FURS, a favorable SFR could be achieved at the start of learning.

Supine versus prone percutaneous nephrolithotomy: A comparison of efficacy and safety in obese patients

Objective: To compare prone and supine percutaneous nephrolithotomy (PNL) in obese patients with respect to efficacy and safety.Material and Methods: Individuals with kidney stones larger than 2 cm undergoing either prone or supine position PNL were included in the study based on the World Health Organization (WHO) classification of body mass index (BMI) ≥30 kg/m2 between January 2011 and September 2020 retrospectively. Demographic characteristics, intraoperative, postoperative data, and complications according to Modified Clavien Grading System were listed. Patients were followed for 3 months, documenting their stone-free status. Results: Out of the total 156 obese patients, 74(47.4%) underwent supine PNL (group 1), and 82 (52.6%) were prone to PNL (group 2). There was no statistically significant difference between the groups concerning hemoglobin drop, the number of pelvicalyceal access, blood transfusion, length of hospital stay, complications rates, and stone-free status (p&amp;gt;0.05). The location of pelvicalyceal access (upper, middle, lower calyces) was significantly different (18.9%, 32.4%, 42.6% in group 1, 3.2%, 19.3%, 77.5% in group 2, respectively) (p&amp;lt;0.001). Mean operative times were statistically different between the groups (97.2 ± 18.1 minutes in group 1, 119.5 ± 18.9 minutes in group 2, respectively) (p&amp;lt;0.001).Conclusion: In the prone or supine position, PNL is a safe and effective method for managing kidney stones in obese patients. Access through the upper calyx may be favored in the supine position considering to patient’s characteristics. Additionally, the supine position has the greatest advantage over the prone position due to shorter operative times.

Hands on wet lab and live surgery training in PCNL: Any impact to surgical skills of attending surgeons?

The clinical value and efficiency of hands-on training courses in percutaneous nephrolithotomy (PCNL) remains undocumented. During the last 9 years, a two-day international intensive hands-on training course in fluoroscopic guided prone PCNL is taking place in our department on a monthly basis. Course includes wet lab training in the porcine model and live surgery training. In this work we report the outcomes of a survey send to course participants questioning the impact of the course to their clinical practice. A survey consisting of 26 questions was distributed online to a total of 91 trainees that had completed the course. Comparison of pre and post course surgical practices was performed using the "N-1" Chi-squared test. A total of 64 trainees responded to our online survey with 55.6% and 41.3% reporting a modest or major impact to their practice accordingly. Notable changes in puncture and dilation technique were evidenced while a uniform reduction in puncture and operative times was documented. 79.4% responded that the course increased the safety of their procedure, 73% that it reduced operating times, 39.7% that increased their stone free rates, 23.8% that reduced their complications and 23.8% that induced to change their instrumentation with respect of that they were using in the past. Subgroup analysis including only well experienced surgeons revealed a similar impact to their practice. In the proper setting, an intensive hands-on PCNL course can have a significant impact on attending physicians. Participation to such events even for experienced surgeons should be encouraged.