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Referral to a urologist is advised in those with persistent or refractory urinary complaints. Urodynamic evaluation allows determination of the underlying bladder disorder; however, post-void residuals suffice in the uncomplicated patient. The pathophysiology of urinary dysfunction and current investigation and treatment modalities are discussed.

Our study shows that Entonox is a safe, rapidly acting and effective form of analgesia for the pain of prostate biopsy. We believe that it should be the analgesia of choice for this procedure.

The ureteral stent symptom questionnaire revealed that pain, urinary symptoms index, and general health were statistically better in the Memokath group. The Memokath group significantly outperformed the Double-J stent group in terms of the light and heavy activity. In terms of future stent insertion, patients preferred the Memokath stent. In the subgroup who had experienced both stents, the Memokath questionnaire revealed improvements in the domain of pain and the lower urinary tract symptoms index, though this was not statistically significant. This may reflect the small size of the study population. There were improvements in general health and other quality-of-life parameters, and there was a tendency in favor of the Memokath.

ObjectivesTo present the chronological development of the different positions described for percutaneous nephrolithotomy (PCNL), in an attempt to identify the reasons for their development and to highlight their specific advantages and disadvantages.MethodsPrevious reports were identified by a non-systematic search of Medline and Scopus.ResultsThe classic prone position for PCNL was first described in 1976. The technique was gradually standardised and PCNL with the patient prone became the generally accepted standard approach. In the next 35 years many other positions were described, with the patient placed prone, lateral or supine in various modifications. Modifications of the classic prone position in the early 1990s aimed to provide the option of a simultaneous retrograde approach during the procedure. As PCNL became more popular the lateral position was first described in 1994, to allow the application of PCNL to patients who were unable to tolerate being prone because of their body habitus. The supine position for percutaneous access was originally described even before 1990, but become more popular after 2007 when the Galdakao modification was reported. Several other modifications of the supine position have been described, with the latest being the flank-free modified supine position, which allows the best exposure of the flank among the supine positions. Each position has its specific advantages and disadvantages.ConclusionUrologists who perform PCNL should be familiar with the differences in the positions and be able to use the method appropriate to each case.

Study Type – Therapy (case series)Level of Evidence 4What's known on the subject? and What does the study add?Supine percutaneous nephrolithotomy (PCNL) has been described for over a decade and has equivalent success rates when compared with the more widely used prone position. The supine position offers a shorter operative duration with better access to the airway for the anaesthetist and also allows for simultaneous retrograde intra‐renal surgery (RIRS). Various supine positions have been described but there is little data regarding their differing benefits and disadvantages.The present study looks at the different supine PCNL positions and compares the strengths and weaknesses of each. Each of the previously described supine PCNL positions have some limitations, e.g. ease of puncture under image guidance, the ability and ease of making and dilating multiple tracts, and allowing simultaneous RIRS. The new ‘Barts flank‐free modified supine position’ is described, which seems to offer a good compromise and addresses some of these issues. It is important to highlight that one supine position does not fit all and the endourologist should familiarise themselves with these positions so the appropriate position can be used for the right patient and stone burden.OBJECTIVE To discuss the relative merits of the different described supine positions for percutaneous nephrolithotomy (PCNL) and highlight the new ‘Barts flank‐free modified supine position’, as the last decade has seen the emergence of various supine positions for PCNL. MATERIALS AND METHODS We reviewed English publications on supine PCNL to look at the different positions being used to carry out PCNL and their relative merits. We describe the new ‘Barts flank‐free modified supine position’, which we think will add significantly to the armamentarium of the endourologist. RESULTS Five different supine positions are discussed. These include the complete supine, the Valdivia, the Galdakao modified Valdivia, the Barts modified Valdivia and the herein described Barts flank‐free modified supine position These positions all differ in regard to ease of puncture under image guidance, operative field availability, ability to make multiple tracts and the ease of combining retrograde intra‐renal surgery. CONCLUSIONS All of the supine positions decrease operative duration, as there is no need for repositioning and allow quick access to the airway for the anaesthetist. However, one supine position does not fit all and the right one must be chosen for the right patient with the right stone burden. It is important for endourologists of today to familiarise themselves with these positions to be able to make these judgements.

The full lateral position-while necessitating expertise and some learning for renal puncture from an unusual angle-is safe in medical high-risk patients. It can be safely performed using regional anesthesia, avoiding the risks of general anesthesia and allowing for patient-anesthetist communication throughout the procedure. Cardiac and respiratory parameters are improved, stable, and easily controlled. As opposed to the supine position, the awake patient is more comfortable, and morbid obesity is not a problem.