When prone position is contraindicated or not preferable, can supine percutaneous nephrolithotomy solve the problem?

Youssef, Ayda; Esmat, Mohamed; Wael, M. Hassan

doi:10.1590/s1677-55382012000100008

Cited by 4 publications

(3 citation statements)

References 16 publications

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“…This position allowed simultaneous antegrade and retrograde access to the urinary tract. After introduction of this position several other authors published studies [5] , [7] , [9] , [10] confirming the efficacy and safety of supine PCNL for treating most renal stones. The Barts flank-free modified supine position made further modifications allowing a wider field for percutaneous access [6] .…”

Section: Discussionmentioning

confidence: 92%

Percutaneous nephrolithotomy in complete supine flank-free position in comparison to prone position: A single-centre experience

Sohail

Albodour

Abdelrahman

2017

Arab Journal of Urology

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ObjectivesTo assess the outcomes of performing percutaneous nephrolithotomy (PCNL) in a modified supine position, more feasible for surgeons, anaesthetists, and operating theatre staff, as well as for the patient himself, and evaluating it in comparison to the standard prone position.Patient and methodsA retrospective, case-control study was conducted between January 2011 and December 2015. In all, 197 patient’s records were reviewed. The initial 101 patients were operated upon in prone position. From mid-2013, 96 patients were operated upon in a complete supine, flank-free position. The groups were compared in terms of operation time, calculated from positioning the patient after anaesthesia induction, insertion of ureteric catheter, puncture of renal system, until the end of procedure; stone-free rate; hospital stay; and postoperative complications, such as transfusion rate, fever, and urinary leakage.ResultsThere were two significant differences between the groups. Firstly, the operation time was a mean (SD) 32.3 (6.6) min shorter for the supine versus the prone position (P < 0.001). Secondly, hospital stay was a mean (SD) 1.2 (0.75) days shorter for the supine vs the prone position (P < 0.001). The complete stone clearance rate (85.4% for supine vs 79.2% for prone; P = 0.2) and postoperative complications (7.3% for supine vs 17.8% for prone; P = 0.02) were comparable in both groups.ConclusionSupine PCNL is a feasible procedure with similar outcomes in terms of stone-free rate as well as postoperative complications, to the standard prone PCNL. It reduces unnecessary delay that occurs during change of position resulting in significant shortening of the total operation time and surgeons can perform supine PCNL whilst sitting.

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Section: Discussionmentioning

confidence: 92%

Percutaneous nephrolithotomy in complete supine flank-free position in comparison to prone position: A single-centre experience

Sohail

Albodour

Abdelrahman

2017

Arab Journal of Urology

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“…[20] There are very few studies concerning the role and outcome of regional anesthesia in supine PCNL. [22] But in our best knowledge there is no data available in the literature regarding anesthetic outcome for supine totally tubeless/tubeless PCNL. Our study enlightens the role of regional anesthesia (spinal with epidural) in said procedures.…”

Section: Discussionmentioning

confidence: 99%

Observational prospective study for surgical outcome and anesthetic feasibility of tubeless and totally tubeless supine PCNL: A single centre initial experience

Gupta

Maurya

Pal

2019

Turkish Journal of Urology

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Objective: To evaluate surgical outcome and spinal anesthetic feasibility of supine percutaneous nephrolithotomy (PCNL) by tubeless and totally tubeless method. Material and methods: This observational study included a totally 53 patients. Initial diagnosis of renal stone was based on urinary ultrasonography, kidney, ureter and bladder X-ray, and later confirmed by computed tomography urography. PCNL was done with the patient in Galdakao-modified supine Valdivia position. Nephrostomy was not done using tubeless method, while in totally tubeless method instead of insertion of double j stent, ureteral catheterization was done and the ureter catheter was kept for <24 hours. During postprocedural period, patients were observed for development of fever, perinephric collection, need for blood transfusion and duration of hospital stay. Results: Patients aged between 14 and 75 years were included in the study. Out of totally 53 patients, supine tubeless PCNL was done in 23 patients while 30 were operated using totally tubeless method. Twenty-nine patients were induced by spinal anesthesia and 24 by general anesthesia. Stone sizes were found to be in the range of 1.4cm to 5.1 cm. Forty-six (86.7%) patients were managed by inferior calyceal puncture. Three patients required double puncture in whom 2 had developed perinephric collection. Complete stone clearance achieved in 49 (92.4%) patients. Four patients developed fever and 2 cases required one unit blood transfusion postoperatively. Conclusion: Tubeless and totally tubeless supine PCNL is technically feasible with good surgical outcomes and can be done under spinal and general anesthesia in properly selected patients.

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“…All PCNL procedures included in this meta-analysis were performed with patients in the prone position. While studies comparing prone to supine positions have demonstrated no significant difference in infection complications ( 28 - 30 ), this aspect should still be considered.…”

Section: Discussionmentioning

confidence: 97%

Postoperative antibiotic prophylaxis for percutaneous nephrolithotomy and risk of infection: a systematic review and meta-analysis

Talizin,

Danilovic,

Torricelli

et al. 2024

Int. braz j urol.

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Purpose: The aim of this study is to perform a high-quality meta-analysis using only randomized controlled trials (RCT) to better define the role of postoperative antibiotics in patients undergoing percutaneous nephrolithotomy (PCNL). Materials and Methods: A literature search for RCTs in EMBASE, PubMed, and Web of Science up to May 2023 was conducted following the PICO framework: Population—adult patients who underwent PCNL; Intervention—postoperative antibiotic prophylaxis until nephrostomy tube withdrawal; Control—single dose of antibiotic during the induction of anesthesia; and Outcome—systemic inflammatory response syndrome (SIRS) or sepsis and fever after PCNL. The protocol was registered on the PROSPERO database (CRD42022361579). We calculated odds ratios (OR) and 95% confidence intervals (CI). A random-effects model was employed, and the alpha risk was defined as < 0.05. Results: Seven articles, encompassing a total of 629 patients, were included in the analysis. The outcome of SIRS or sepsis was extracted from six of the included studies, while the outcome of postoperative fever was extracted from four studies. The analysis revealed no statistical association between the use of postoperative antibiotic prophylaxis until nephrostomy tube withdrawal and the occurrence of SIRS/sepsis (OR 1.236, 95% CI 0.731 – 2.089, p=0.429) or fever (OR 2.049, 95% CI 0.790 – 5.316, p=0.140). Conclusion: Our findings suggest that there is no benefit associated with the use of postoperative antibiotic prophylaxis until nephrostomy tube withdrawal in patients undergoing percutaneous nephrolithotomy (PCNL). We recommend that antibiotic prophylaxis should be administered only until the induction of anesthesia in PCNL.

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When prone position is contraindicated or not preferable, can supine percutaneous nephrolithotomy solve the problem?

Abstract: ARTICLE INFO___________________________________________ _

Cited by 4 publications

References 16 publications

Percutaneous nephrolithotomy in complete supine flank-free position in comparison to prone position: A single-centre experience

Percutaneous nephrolithotomy in complete supine flank-free position in comparison to prone position: A single-centre experience

Observational prospective study for surgical outcome and anesthetic feasibility of tubeless and totally tubeless supine PCNL: A single centre initial experience

Postoperative antibiotic prophylaxis for percutaneous nephrolithotomy and risk of infection: a systematic review and meta-analysis

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When prone position is contraindicated or not preferable, can supine percutaneous nephrolithotomy solve the problem?

Abstract: ARTICLE INFO_______________________________________________________________ _____________________

Cited by 4 publications

References 16 publications

Percutaneous nephrolithotomy in complete supine flank-free position in comparison to prone position: A single-centre experience

Percutaneous nephrolithotomy in complete supine flank-free position in comparison to prone position: A single-centre experience

Observational prospective study for surgical outcome and anesthetic feasibility of tubeless and totally tubeless supine PCNL: A single centre initial experience

Postoperative antibiotic prophylaxis for percutaneous nephrolithotomy and risk of infection: a systematic review and meta-analysis

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Abstract: ARTICLE INFO___________________________________________ _