Flank free modified supine position: A new modification for supine percutaneous nephrolithotomy

Abstract

ObjectivesPercutaneous nephrolithotomy (PCNL) is the standard management for large and/or complex urolithiasis, but the standard patient position for PCNL is undecided. With the patient prone PCNL has several drawbacks, while when supine, as described previously, PCNL has mechanical limitations. We describe a modification that aims to overcome these limitations and provide easy access comparable to that in the prone position.Patients and methodsThis prospective study was carried out at the Urology Department, Zagazig University, Egypt, from October 2008 to March 2011, and included 78 patients (48 men and 30 women). First the patient was placed supine and then in the ‘flank-free modified’ supine position. The distance between the last rib and the iliac crest in the posterior axillary line was measured in both positions.ResultsThe mean age of the patients was 40.8 years, the mean (SD) stone diameter was 3.4 (0.7) cm, the number of right/left stones was 34/44, and mean body mass index was 28.8 kg/m2. The mean (SD) increase in the distance between the last rib and the iliac crest in the posterior axillary line in the flank free modified supine position vs. the previous supine position was 12 (0.8) mm.ConclusionThe flank-free modified supine position increases the distance between the last rib and the iliac crest, and, together with the absence of a cushion under the flank, provides ample space for puncture, dilatation, multiple tracts and manoeuvrability of the system with the nephroscope.

Free-flank modified supine vs. prone position in percutaneous nephrolithotomy: A prospective randomised trial

“…Only the operative time was statistically significantly different ( P < 0.001). This is in accordance with the findings of many urologists [6,9,11,12,17] , and it reflects the time lost when turning the patient at the beginning and the end of the procedure in group B. This position also does not allow simultaneous antegrade and retrograde endourological access [18] .…”

“…Several authors [6,9,11,12] favour the supine position as far as recommending that it replaces the SPP. Despite these reports, the supine position has not become popular, which might be attributed to the limited freedom in manipulating the access and the stone with a 3-L water bag under the flank, as described by Valdivia Uria et al [9] .…”

“…The supine position has mechanical limitations. Desoky et al [11] described the free-flank modified supine position (FFMSP) and assumed that this position overcomes the mechanical limitation by providing ample space for PCNL. In the present study we compared PCNL in both the FFMSP and the standard prone position (SPP) for the technical aspects, safety, stone-free rate, operative time, X-ray exposure, complications, and the need for a second PCNL and/or ESWL.…”

Supine Percutaneous Nephrolithotripsy in Double-S Position

“…A similar supine position has been reported by Desoky et al and published in the Arab Journal of Urology in 2012 [ 18 ]. Desoky's position differs, however, from the double-S for the positioning of the patient's legs—slightly split in ours, and crossed in the flank-free position he described—and does not allow for the use of retrograde access in the upper urinary tract, which is instead always possible in ours.…”

95 Immediate versus delayed shock wave lithotripsy for inaccessible stones after uncomplicated percutaneous nephrolithotomy

“…PCNL was done in the flank-free modified supine position [13]. The skin was punctured at the posterior axillary line.…”