Percutaneous Lithotripsy in Valdivia-Galdakao Decubitus Position: Our Experience

Abstract

Percutaneous nephrolithotripsy (PNL) is actually the first therapeutic option to resolve complex renal stones. Our department initiated its experience in 1985 and treated the first 585 patients in ventral decubitus, as the original technique was described. Then, in 1998, the dorsal decubitus was adopted (Valdivia Uria), in which 695 patients were treated. Since 2006 the Valdivia Galdakao variant has been used. The Valdivia Galdakao position is an intermediate dorsal decubitus with extension of its homolateral lower limb and flexion of the contralateral. It is a practical way to place the patient for percutaneous renal surgery, avoiding hyperextensions and hyperflexions that can result in articular damage. It preserves cardiovascular and ventilatory dynamics and allows a better access to the respiratory tract. In this position, the bowel slips away from the puncture area lowering the risk of its damage. A single lumbar and genital sterile surgical field is created allowing antegrade and retrograde simultaneous endoscopic and even laparoscopic access, increasing efficiency and safety of the minimal invasive procedures. Between April 2006 and March 2008, 175 PNLs were performed in our department with the patient in Valdivia Galdakao position. The aim of this article is to describe our experience in this decubitus confirming that the Valdivia Galdakao is a safe, practical and versatile position that should be considered as first choice when a percutaneous renal surgery is indicated.

Supine Versus Prone Position During Percutaneous Nephrolithotomy: A Report from the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study

“…10,11 A further development has been the Valdiva Galdakao variant developed in 2006, which introduces some rotation to the supine position by positioning the contralateral leg in flexion and the ipsilateral leg in extension. 12 In addition, comparative studies 13,14 and comprehensive reviews 15,16 assessing differences between prone and supine patient positioning during PCNL have been published. Despite the accumulating literature, however, it remains unclear whether one method of patient positioning is optimal over the other.…”

Endoscopic Combined Intrarenal Surgery for Large Calculi: Simultaneous Use of Flexible Ureteroscopy and Mini-Percutaneous Nephrolithotomy Overcomes the Disadvantageous of Percutaneous Nephrolithotomy Monotherapy

“…The Galdakao-modified supine Valdivia position may be a more familiar approach for simultaneous use of fURS and PCNL. [24][25][26][27][28] The supine position has anesthesiologic advantages, including elimination of cardiovascular and respiratory problems. 26 Renal pelvis pressure is also lower when the patient is in the supine position, reducing the risk of fluid absorption.…”

“…26 Renal pelvis pressure is also lower when the patient is in the supine position, reducing the risk of fluid absorption. 27 Disadvantages of the supine position include constant collapse of the pyelocaliceal system and difficulties while performing upper-pole caliceal puncture. These problems necessitate longer tracts and reduce nephroscope mobility, particularly in obese patients.…”

Effectiveness of Ureteroscopy-Assisted Retrograde Nephrostomy (UARN) for Percutaneous Nephrolithotomy (PCNL)

“…Under general and epidural anesthesia, the patient was placed in the Galdakao-modified Valdivia position [6], [7], [8], [9] [10]. A 6 Fr rigid ureteroscope (Uretero-Renoscope®, Karl Storz, Tuttlingen, Germany) was advanced; if it did not encounter either ureteral stenosis or ureteral stones, a flexible ureteroscope (Flex-X 2 ®, Karl Storz, Tuttlingen, Germany) was inserted through a 12/14 Fr (inner/outer) 35 cm ureteral access sheath (UAS) (Flexor®, COOK Urological, IN, USA) or a 11/13 Fr 46 cm UAS (Navigator® 11 Fr 46 cm, Boston Scientific, MA, USA) to the ureter.…”