Percutaneous Nephrolithotomy In Prone Position Research Articles

Management of a case of ankylosing spondylitis for percutaneous nephrolithotomy in prone position under combined spinal epidural anesthesia

Management of a case of ankylosing spondylitis (AS) can be very challenging where airway and central neuraxial blockade, both are difficult. Surgical positioning under anesthesia in these patients is also demanding due to risk of iatrogenic fractures and spinal cord trauma. We present a case of AS for percutaneous nephrolithotomy in prone position performed under combined spinal epidural anesthesia successfully. Regional anesthesia gave us the advantage of having an awake patient who could maintain his head and neck posture thereby minimizing the risk of any neurological deterioration while positioning.

Segmental epidural Anesthesia in an obese patient undergoing percutaneous Nephrolithotomy in prone position

The increasing incidence of obesity is a crisis in health care where these patients are increasingly being anesthetized for nonbariatric surgery. Anesthetizing an obese patient is a challenge and more so if surgery is to be done in prone position. We would like to present a patient, a 59-year-old male with body mass index of 45 (weight: 145 kg; height: 178 cm; abdominal girth: 135 cm) with a history of diabetes mellitus, hypertension, and chronic obstructive pulmonary disease since 10 years posted for a left-sided percutaneous nephrolithotomy. Successfully managed under epidural anesthesia and operated in the prone position.

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.

Percutaneous Nephrolithotomy for Staghorn Stones in Patients with Solitary Kidney in Prone Position or in completely Supine Position: a Single-center Experience

To evaluate the effectivity and safety of percutaneous nephrolithotomy (PCNL) in the treatment of solitary kidney with staghorn stones in prone position or in completely supine position. We retrospectively reviewed the records of 18 patients with staghorn stones in a solitary kidney treated with PCNL. 12 patients underwent PCNL in prone position (group A). 6 patients underwent PCNL in completely supine position (group B). Demographic data, number of accesses, operating time, stone free rate, hemoglobin values, hospital stay and complications were studied. Serum creatinine, systolic and diastolic blood pressure, and new onset hypertension were determined preoperatively and postoperatively at 3 months. No blood transfusions were required and no abdominal or thoracic organ injuries were reported in both groups. The mean operative time was 104 minutes (range: 72-145 minutes) and 128 minutes (range: 80-170 minutes), respectively. The I stage stone free rate was 91.7 % and 83.3 %, respectively. There was no new onset hypertension by the end of follow-up in both groups. Both groups showed a similar fall in serum creatinine at 3 month follow-up period (p = 0.004 and 0.029, respectively). Systolic blood pressure showed a statistically significant improvement in group B (p = 0.034). PCNL is safe and has an acceptably high stone free rate in patients with solitary kidneys in both prone and completely supine position. At short-term follow-up, systolic blood pressure had improved in PCNL in supine position.

The Learning Curve for Flank Percutaneous Nephrolithotomy for Kidney Calculi: A Single Surgeon's Experience

PurposePercutaneous nephrolithotomy (PCNL) is conventionally conducted in the prone position. However, the prone position increases anesthesia-related morbidity and position changes lengthen the operation time. We report perioperative outcomes and the learning curve for flank PCNL on the basis of a single surgeon's experience.Materials and MethodsThis study investigated 53 cases of flank PCNL performed for renal stones at our institution from April 2008 to September 2010. We compared mean operative time, stone-free rate, drop in hemoglobin level, length of hospital stay, complications, and need for additional procedures after the surgery. The 53 cases were divided into three groups by case number to compare therapeutic effect, stability, and the learning curve for flank position PCNL.ResultsThe mean operation time for the 53 patients was 97.3±43.1 minutes. The mean operation time gradually decreased as the surgeon accumulated experience. From the 36th case, the mean operation time showed a statistically significant decrease to 72.2±24.1 minutes (p=0.003). The overall stone-free rate was 64.2% for all procedures (range, 61.1-76.5%). There were no significant differences in the drop in hemoglobin level, stone-free rate, re-treatment, hospital stay, or complication rate. There was no injury to the bowel or renal vessels, and no other major complications occurred.ConclusionsFlank PCNL can be used to remove renal stones effectively while overcoming the disadvantages of the existing prone position PCNL. After 36 cases, the learning curve showed acquisition of surgical competence. The clinical experience reported here suggests that flank PCNL is a safe and feasible technique.

X-ray-free percutaneous nephrolithotomy in supine position with ultrasound guidance

Supine percutaneous nephrolithotomy (PCNL) has numerous benefits compared to the prone position, including lower anesthesia risk, shorter operating time, and better ergonomic position for the surgeon. It is also comparable to prone position regarding vascular and bowel injuries. This study was conducted to add some more benefits by omitting X-ray in PCNL in a supine position. Nineteen consecutive adult patients underwent ultrasound-guided PCNL in supine position. All patients were placed under ultrasound guidance in supine position. The tract was dilated over a guidewire in a single shot technique under ultrasound guidance from anterior abdominal wall. Once the procedure ended, residual stone was controlled using ultrasound with anterior abdominal wall window. Residual stones less than 5 mm were considered insignificant. No X-ray was used in any setting of the procedure. The pelvicaliceal system could be successfully approached in all patients. The posterior calices were the most common sites of entry. Mean (range) of operation time was 111 (70-180) min. Mean + or - SD hemoglobin before PCNL was 14.0 + or - 2.2 mg/dl, and after the procedure it was 12.3 + or - 1.6 mg/dl. Only one patient required blood transfusion. Mean + or - SD creatinine before PCNL was 1.03 + or - 0.24 mg/dl, and after the procedure it was 1.11 + or - 0.22 mg/dl. None of the patients suffered visceral injury. The total stone-free rate was 84%. Even in our first report with limited experience, it seems that the efficacy of PCNL with ultrasonography in supine position is comparable to PCNL in prone position with fluoroscopy with no more complications.

Severe Bradycardia in a Myasthenic Patient Undergoing Percutaneous Nephrolithotomy in Prone Position Under General Anaesthesia

Severe Bradycardia in a Myasthenic Patient Undergoing Percutaneous Nephrolithotomy in Prone Position Under General Anaesthesia