Comparative study of percutaneous nephrolithotomy performed in the traditional prone position and in three different supine positions

Melo, Petrônio Augusto de Souza; Vicentini, Fábio Carvalho; Perrella, Rodrigo; Murta, Cláudio Bovolenta; Claro, Joaquim Francisco de Almeida

doi:10.1590/s1677-5538.ibju.2018.0191

“…This result is important so that the surgeons will be able to confidently decide the position based on their experiences and the patient's comorbidities. In addition, the study conducted by Melo et al showed similarities between both positions in terms of the number of puncture tracts, blood transfusion rate, and mean drop in hemoglobin level 11 .…”

Section: Discussionmentioning

confidence: 92%

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

Birowo

¹

,

Tendi

²

,

Widyahening

³

et al. 2020

View full text Add to dashboard Cite

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.

show abstract

“…Stone free condition is defined as the absence of residual fragments of ≤ 4 mm after procedure. Major complications are defined as those with a Clavien score of III or more 12 .…”

Section: Data Extractionmentioning

confidence: 99%

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

Birowo

¹

,

Tendi

²

,

Widyahening

³

et al. 2020

View full text Add to dashboard Cite

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.

show abstract

“…Більш того, дослідження in vitro засвідчило, що тиск у нирковій мисці вище 30 мм рт.ст. (3,99 кПа) протягом більше 50 с значно збільшує частоту післяопераційної лихоманки [27,28]. Автори зробили висновок, що інтраопераційна гіпертензія ниркової миски із загальним часом більше 5 хв є статистично значущою у ризику розвитку післяопераційної лихоманки, а постійний високий тиск у нирковій мисці є ключовим фактором, що призводить до піеловенозного рефлюксу і післяопераційних ускладнень.…”

Section: матеріали та методиunclassified

“…У даному дослідженні післяопераційні інфекційні ускладнення, включаючи гіпертермію, були подібними у 1-й і 2-й групах (9,5% проти 7,1%; р>0,05), що знаходить підтвердження в порівняльних дослідженнях інших авторів, де частота інфекційних ускладнень була такою самою, що можна порівняти між пацієнтами, які перенесли ПНЛ як в положенні лежачи на спині, так і в положенні лежачи на животі [28].…”

Section: матеріали та методиunclassified

Percutaneous Nephrolithotripsy in the Position of the Patient Lying on His Back

Сагалевич

¹

,

Vozianov

²

,

Gaysenyuk

³

et al. 2021

View full text Add to dashboard Cite

The objective: evaluation of the effectiveness and safety of percutaneous nephrolithotripsy in patients in the supine position. Materials and methods. For the period 2017–2021, 521 mini-PNL were performed according to the standard technique, where in 458 (87,9%) cases the operation was performed in the patient’s prone position, and in 63 (12,1%) cases on the supine position (group 1). The control group (2 group) consisted of 70 patients, sporadically selected among 458 patients to whom PML performed in a standard prone position. Mini-PNL was performed under combined regional (spinal-epidural) anesthesia in 98,7% (514) cases, in 1,3% (7) under endotrachial anesthesia. Results. The average time of surgery was 41,1±11,4 minutes in the 1st group and 57,4±10,3 minutes in the 2nd group (р<0,05), due to the lack of need to revolutionize the patient on the abdomen. Statistically greater (p<0,05) of the ability to perform/ additional percutaneous access in patients in the supaine position. Infectious complications (9,5 vs. 7,1%; p>0,05), stone-free conditions (96,4 vs. 98,2%; p>0,05) and average hospital stays (2,3 vs. 2,2 days; p>0,05). None of the patients in both groups had complications higher than Clavien IIIa. When performing PNL in the supine position, in contrast to performing PNL on the prone position, there is always the possibility of using combined endoscopic methods. Where 3 (4,8%) patients underwent combined retro- and antegrade approaches for combination of nephrolithiasis with «wedged» calculi of the pyelourethral segment and in distal ureter, and retrograde laser endoureterotomy was performed in one (1,6%) patient. The limitation of our study includes a small sample size and a lack of group randomization. Conclusions. The patient’s position on the supine position, during the implementation of PNL, is a safe technique and can be a particularly attractive option for the category of patients with high anesthesiological risk; in the case of planned simultane (transurethral and percutaneous) interventions on the UMP; in patients who are obese or with severe deformityof the spine.

show abstract

Comparative study of percutaneous nephrolithotomy performed in the traditional prone position and in three different supine positions

Cited by 21 publications

References 20 publications

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

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

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

Percutaneous Nephrolithotripsy in the Position of the Patient Lying on His Back

Contact Info

Product

Resources

About