Chonnam Med J.  2014 Aug;50(2):52-57. 10.4068/cmj.2014.50.2.52.

Feasibility and Efficacy of Intermediate-Supine Percutaneous Nephrolithotomy: Initial Experience

• Chung DY
• Lee JY
• Kim KH
• Choi JH
• Cho KS

• KMID: 2172159
• DOI: http://doi.org/10.4068/cmj.2014.50.2.52

Abstract

We evaluated the feasibility and efficacy of intermediate-supine percutaneous nephrolithotomy (PCNL) in patients with renal calculi. Fifteen patients were included in this study. The intermediate-supine operative position was modified by using a 1-L saline bag below the ipsilateral upper flank. A nephrostomy and stone extraction were performed as usual. After completion of the stone removal, a nephrostomy tube was used when necessary according to the surgeon's decision. If there was no significant bleeding or renal pelvic injury, tubeless PCNL was performed. The mean stone size was 5.48+/-5.69 cm2, the mean operative time was 78.93+/-38.72 minutes, and the mean hospital stay was 2.60+/-1.29 days. Tubeless PCNL was performed in 13 cases (86.7%), and retrograde procedures were simultaneously performed without a change of position in 2 patients (ureteroscopic ureterolithotomy in one patient and transurethral placement of an occlusion catheter in one patient). There were two complications according to the Clavien-Dindo classification (Grade I in one patient and Grade II in one patient). The success rate was 80.0% and the complete stone-free rate was 73.3%. Three patients with a significant remnant stone were also successfully managed with additional procedures (one patient underwent a second-look operation, and the remaining two patients were treated with shock wave lithotripsy). In the treatment of renal calculi, intermediate-supine PCNL may be a safe and effective choice that offers several advantages with excellent outcomes. Thus, a prospective study with a larger population is needed to verify our outcomes.

Keyword

Kidney calculi; Supine position; Nephrostomy

MeSH Terms

Catheters
Classification
Hemorrhage
Humans
Kidney Calculi
Length of Stay
Nephrostomy, Percutaneous*
Operative Time
Shock
Supine Position

Figure

• 

  FIG. 1 Intermediate supine and tubeless percutaneous nephrolithotomy. (A) The position was modified using a one liter saline bag below the ipsilateral upper flank in a male patient. (B) Renal stones were removed using LithoClast by the operator and assistant who were seated during the procedure. (C) There was no nephrostomy catheter placed in the puncture site in a female patient after operation.

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