Complete Supine Percutaneous Nephrolithotripsy Comparison with the Prone Standard Technique

Falahatkar, Siavash; Moghaddam, Amin Afshari; Salehi, Mohammad Gharib; Nikpour, Shahriar; Esmaili, Fereshteh; Khaki, Pejvak

doi:10.1089/end.2008.0463

Cited by 142 publications

(101 citation statements)

References 20 publications

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“…In another study, there was a significant relationship between the duration of the operation in the prone and the complete supine PCNL which was significantly lower in the supine position (P value < 0.0001) (15).…”

Section: Discussionmentioning

confidence: 88%

“…In a study on 80 patients who underwent PCNL (40 patients underwent csPCNL and 40 patients underwent prone PCNL), blood transfusion was needed because of the bleeding volume, there was no significant difference between the supine and the prone groups (15). In another study, 28 patients underwent PCNL and irrigation was performed by isotonic solutions such as manitol , in which, bleeding during operation was a warning sign and was an effect of the irrigation fluid used (16).…”

Section: Discussionmentioning

confidence: 99%

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6 Comparative Study of Hemodynamics Electrolyte and Metabolic Changes During Prone and Complete Supine Percutaneous Nephrolithotomy

Khoshrang¹,

Falahatkar²,

Naseh³

et al. 2010

European Urology Supplements

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Background: Nowadays Percutaneous Nephrolithotomy (PCNL) is performed in prone and supine positions. Physiologic solutions should be used to irrigate during PCNL. Irrigation can cause hemodynamic, electrolyte and acid-base changes during PCNL. Objectives: The current study aimed to compare the electrolyte, hemodynamic and metabolic changes of prone and complete supine PCNL. Patients and Methods: It was a randomized clinical trial study on 40 ASA class I and II patients. Twenty of patients underwent prone PCNL (Group A) and the other twenty underwent complete supine PCNL (Group B). The two groups received the same premedication and induction of anesthesia. Blood pressure (systolic, diastolic and mean) and pulse rate were recorded before, during and after anesthesia and Hb, Hct, BUN, Cr, Na, and K were also measured before and after operation in the two groups. The volume of irrigation fluid, total effluent fluid (the fluid in the bucket and the gazes) and volume of absorbed fluid were measured. Results: There were no significant differences in Na, K, BUN, Cr, Hb and Hct between the two groups. Absorption volume was significantly different between the two groups (335 ± 121.28 mL in group A and 159.45 ± 73.81 mL in group B, respectively) (P = 0.0001). The mean anesthesia time was significantly different between the two groups (P = 0.012). There was a significant difference in bleeding volume between supine and prone PCNL (270.4 ± 229.14 in group A and 594.2 ± 290 in group B, respectively) (P = 0.0001). Mean systolic blood pressure during operation and recovery was 120.2 ± 10.9 and 140.7 ± 25.1 in group B, and 113.4 ± 6.4 and 126.2 ± 12.7 in group A, respectively. Systolic blood pressure between the two groups during operation and recovery was significantly different (P = 0.027 and P = 0.022, respectively). Mean diastolic blood pressure in supine group during operation and recovery was 80.53 ± 7.57 and 95.75 ± 17.48, and 73.95 ± 3.94 and 83.4 ± 12.54 in prone group, respectively. Diastolic blood pressure was significantly different between the two groups. It was 80.55 ± 7.57 and 95.75 ± 17.48, respectively during operation and recoveryin the supine group and 73.95 ± 3.94 and 83.4 ± 12.54 in the prone group, respectively (P = 0.001 and P = 0.014, respectively), but there was no significant difference between the pulse rate mean value of the two groups. Conclusions: The electrolyte and metabolic changes were not significantly different between the two groups, and although fluid absorption in prone group was more than that of the complete supine group, there was no significant difference between the two groups. Considering advantages of complete supine PCNL such as less hemodynamic changes (less hypotension, less fluid absorption and less duration of operation) this kind of PCNL was recommended.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

6 Comparative Study of Hemodynamics Electrolyte and Metabolic Changes During Prone and Complete Supine Percutaneous Nephrolithotomy

Khoshrang¹,

Falahatkar²,

Naseh³

et al. 2010

European Urology Supplements

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show abstract

“…Also appropriate prophylactic antibiotics were administered for all patients before and after the operation. All PCNLs were performed with patients in the complete supine position 13 due to the surgeon's experience. Compared with the prone PCNL, the complete supine PCNL is a safe and effective procedure; patients do not need to be repositioned after intubation and catheterization.…”

Section: Methodsmentioning

confidence: 99%

“…The complete supine position also allows us to control the airway appropriately during anesthesia and to sit during surgery. 13 The procedure was initiated by cystoscopy and retrograde insertion of the ureteral stent and followed by puncturing the collecting system with an 18-gauge needle and inserting a 0.035-inch J-tip guidewire using the posterior subcostal access. A one-shot dilation technique (9-Fr dilator, 28-Fr Amplatz dilator), insertion of a 30-Fr Amplatz sheath (by possible and easy slipping and manipulating it over the 28-Fr Amplatz dilator into the collecting system), 13,14 rigid nephroscopy, and pneumatic lithotripsy were performed.…”

Section: Methodsmentioning

confidence: 99%

Factors affecting complications according to the modified Clavien classification in complete supine percutaneous nephrolithotomy

Falahatkar¹,

Moghaddam

Kazemnezhad³

et al. 2015

CUAJ

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Cite as: Can Urol Assoc J 2015;9(1-2):e83-92. http://dx.doi.org/10.5489/cuaj.2248 Published online February 9, 2015. AbstractIntroduction: An increase in percutaneous nephrolithotomy (PCNL) has been accompanied by an increase in complications. We identified the parameters affecting the severity of complications using the modified Clavien classification (MCC). Methods: From 2008 to 2013, 330 patients underwent complete supine PCNL using subcostal access, one-shot dilation, rigid nephroscopy, and pneumatic lithotripsy. We assessed the impact of the following factors on complication severity based on the MCC: age, gender, body mass index, hypertension, diabetes, previous stone surgery and extracorporeal shock wave lithotripsy, preoperative hemoglobin, renal dysfunction (creatinine >1.4 mg/dL), preoperative urinary tract infection, anatomic upper urinary tract abnormality (AUUTA), significant (moderate-severe) hydronephrosis, stonerelated parameters (opacity, number, burden, location, staghorn, complex stones), anesthesia type, kidney side, imaging and calyx for access, tract number, tubeless approach, operative time, postoperative hemoglobin, and hemoglobin drop and stone-free results. Results: The complication rate was 19.7% (MCC: 0=80.3%, I=6.4%, II=11.2%, ≥III=2.1%). On univariate analyses, only the following factors affected MCC: gender, preoperative hemoglobin, AUUTA, significant hydronephrosis, imaging for access, calyx for access, tract number, postoperative hemoglobin, hemoglobin drop and stone-free result. Renal dysfunction was accompanied by higher complications, yet the results were not statistically significant. Multivariate logistic regression analysis demonstrated renal dysfunction, absence of significant hydronephrosis, AUUTA, multiple tracts, lower postoperative hemoglobin, and higher postoperative hemoglobin drop as the significant parameters which affected MCC and predicted higher grades. The paper's limitations include a low number of cases in the higher Clavien grades and some subgroups of variables, and not applying some techniques due to surgeon preference. Interpretation: Many of the complete supine PCNL complications were in the lower Clavien grades and major complications were uncommon. Renal dysfunction, AUUTA, significant hydronephrosis, tract number, postoperative hemoglobin, and hemoglobin drop were the only factors affecting MCC. IntroductionPresently, percutaneous nephrolithotomy (PCNL) is preferred as a safe and effective way to remove large or multiple upper urinary tract calculi. [1][2][3][4][5][6][7] An increase in PCNL has been accompanied by variations in positions, techniques, and instruments, and these may have led to increased complications.1,2,4,5 Following PCNL, 79.5% of patients may experience an uncomplicated postoperative period, 5,8 although there are reports of an early complication rate of 50.8%. 4PCNL complications may occur during puncturing, access, or stone removal. 4 A standardized classification allow us to compare complications among different instruments, te...

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“…7 Compared with prone PCNL, supine PCNL is an appropriate method due to convenience of patient and surgeon, lack of patient re-position for intubation and catheterization, proper control of airway, simultaneous accomplishment of ureteroscopy and PCNL, lower pressure of the collecting system and easier evacuation of stone fragments, shorter operative time and similar outcomes. [7][8][9][10] Convenient insertion of a percutaneous tract is necessary to successfully remove the stone. Access to the collecting system is performed via upper, middle and lower calices.…”

Section: Introductionmentioning

confidence: 99%

Middle calyx access in complete supine percutaneous nephrolithotomy

Falahatkar

Kazemnezhad

Moghaddam

et al. 2013

CUAJ

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Background: Middle calyx access has been underused in percutaneous nephrolithotomy (PCNL), especially in the supine position. We compared the safety and efficacy outcomes between middle calyx and lower calyx accesses in the complete supine PCNL in a non-randomized single-surgeon clinical study. Methods: Between February 2008 and October 2011, 170 patients underwent posterior subcostal single tract complete supine PCNL with one-shot dilation and middle calyx (n = 48) and lower calyx (n = 122) accesses. Stone location and surgeon decision determined target calyx for access. Inclusion criteria were pelvis stones, staghorn stones and multiple location stones. Exclusion criteria were renal anomalies, only upper calyx stones, only middle calyx stones and only lower calyx stones. Important parameters were compared between the two groups. A p value of <0.05 was considered significant. Results: Two groups were similar in important patient-and stonerelated parameters. Mean operative time (60.7 minutes), mean postoperative hospital stay (1.84 days) and mean hemoglobin drop (0.67 g/dL) in the middle calyx group were significantly lesser than in the lower calyx group (80.1 minutes, 2.19 days, 1.36 g/dL). The middle calyx group (89.6%; 79.6%) had a higher stone-free rate (p = 0.054) and efficiency quotient than the lower calyx group (76.2%; 61.6%). In the middle calyx group (10.4%; 2.1%), complication and transfusion rates were lesser (p > 0.05) than lower calyx group (14.8%; 7.4%). No significant difference (p = 0.40) was seen between two groups using the modified Clavien classification of complications. Interpretation: Middle calyx can be an optimal access in PCNL with the complete supine position for many of upper urinary tract stones due to its superior outcomes.

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Complete Supine Percutaneous Nephrolithotripsy Comparison with the Prone Standard Technique

Cited by 142 publications

References 20 publications

6 Comparative Study of Hemodynamics Electrolyte and Metabolic Changes During Prone and Complete Supine Percutaneous Nephrolithotomy

6 Comparative Study of Hemodynamics Electrolyte and Metabolic Changes During Prone and Complete Supine Percutaneous Nephrolithotomy

Factors affecting complications according to the modified Clavien classification in complete supine percutaneous nephrolithotomy

Middle calyx access in complete supine percutaneous nephrolithotomy

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