Preoperative Planning with Noncontrast Computed Tomography in the Prone and Supine Position for Percutaneous Nephrolithotomy: A Practical Overview

Marchini, Giovanni Scala; Berto, Fernanda Christina Gabrigna; Vicentini, Fábio Carvalho; Chen, Shan; Srougi, Miguel; Mazzucchi, Eduardo

doi:10.1089/end.2014.0299

Cited by 22 publications

(13 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Preoperative radiological diagnostics is an important tool for the planning percutaneous access, and identifying eventual conflicts of the possible tract with adjacent organs (e.g. spleen, liver and colon) as a cause of major complications [8,12].…”

Section: Discussionmentioning

confidence: 99%

“…SSD was calculated as the arithmetic mean of three distances from the middle of the dominant stone to the skin, at 0º, 45º and 90º on axial CT images [7]. According to Marchini et al [8] ITL was determined as the distance between the bottom of the lower calyx and the skin, on an imaginary line from the antero-lateral edge of the vertebra, through the bottom of the posterior calyx to the skin (Fig. 1).…”

Section: Methodsmentioning

confidence: 99%

“…1). An access angle was drawn on axial CT images, with the vertex in the bottom of the punctured calyx, one leg adjacent to the lateral circumference of the paraspinous muscles and the other at the first adjacent organ [8] (Fig. 1).…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

New computed tomographic predictors of complicated perioperative course of 17.5F mini-percutaneous nephrolithotomy (mini-PNL)

et al. 2020

View full text Add to dashboard Cite

Purpose Radiological parameters predicting a postoperative stone-free status (SFS) or a complicated perioperative course of mini-PNL, are scarce. Our aim was to identify such factors for prone 17.5F mini-PNL. Methods A monocentric cohort of 103 cases was retrospectively analysed for factors predicting SFS and relevant complications, i.e. Clavien-Dindo (CD) ≥ 2. Parameters measured on preoperative supine CT included maximal stone diameter, skin-to-stone distance (SSD), ideal tract length (ITL), access angle, minimal T12-Lower Kidney Pole distance (T12LP) and minimal Iliac Crest-Lower Kidney Pole distance (ICLP). Infundibulopelvic angle (IPA) was measured on intraoperative pyelography. Results The median maximal stone diameter was lower in cases with postoperative SFS [16 mm (Min. 10; Max. 35) vs. 20 mm (Min. 6; Max. 85), p = 0.0052]. CD ≥ 2 was more frequent in cases with a bigger stone burden [19 mm (Min. 13; Max. 85) vs. 16 mm (Min. 6; Max. 49), p = 0.0056] and with the ribs in the access angle [7/23 (30.43%) vs. 8/76 (10.53%); p = 0.0454]. T12LP significantly differed in cases with and without CD ≥ 2 [80.48 mm (± 21.31) vs. 90.43 mm (± 19.42), p = 0.0397]; however, it had no influence on SFS (p > 0.05). SSD, ITL, IPA and ICLP were significant regarding neither SFS nor CD ≥ 2 prevalence (p > 0.05). Using multivariate logistic regression, T12LP was confirmed as an independent predictor on CD ≥ 2 prevalence. Conclusions Preoperative computed tomographic factors indicating elevated kidney position influence perioperative course of mini-PNL. T12LP and the presence of ribs in the access angle are, apart from stone diameter, the most useful indicators for cases at risk of CD ≥ 2.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

New computed tomographic predictors of complicated perioperative course of 17.5F mini-percutaneous nephrolithotomy (mini-PNL)

et al. 2020

View full text Add to dashboard Cite

show abstract

“…It could explain the lower sepsis rate observed in supine cases, but the lack of postoperative culture data may have limited this conclusion. More visceral injuries observed in prone cases possibly are a consequence of a higher rate of intercostal punctures, which is expected since kidneys are more cranially arranged in the abdomen in prone decubitus ( 18 ). Sofer et al also showed that there is great approachability to the upper calyx through the inferior calyx, reducing the need for intercostal punctures when using supine decubitus ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

Impact of patient position on the outcomes of percutaneous neprolithotomy for complex kidney stones

et al. 2018

View full text Add to dashboard Cite

Purpose:To evaluate the impact of the patient position on the outcomes of PCNL among patients with complex renal stones.Material and Methods:From July 2011 to July 2014, we collected prospective data of consecutive patients who underwent PCNL. We included all patients with complex stones (Guy's Stone Score 3 or 4 (GSS) based on a CT scan) and divided them based on the position used during PCNL (prone or supine). The variables analyzed were gender, age, body mass index, ASA score, stone diameter, GSS, number of punctures, calyx puncture site, intercostal access and patient positioning. Complications were graded according to the modified-Clavien Classification. Success was considered if fragments ≤ 4mm were observed on the first postoperative day CT scan.Results:We analyzed 240 (46.4%) of 517 PCNL performed during the study period that were classified as GGS 3-4. Regarding patient positions, 21.2% were prone and 79.8% were supine. Both groups were comparable, although intercostal access was more common in prone cases (25.5% vs 10.5%; p=0.01). The success rates, complications, blood transfusions and surgical times were similar for both groups; however, there were significantly more visceral injuries (10.3% vs 2.6%; p=0.046) and sepsis (7.8% vs 2.1%; p=0.042) in prone cases.Conclusion:Supine or prone position were equally suitable for PCNL with complex stones and did not impact the success rates. However, supine position was associated with fewer sepsis cases and visceral injuries.

show abstract

“…Moreover, we also have to consider that, as done by the majority of urologists, the fact that the preoperative CT scan is mostly carried out in the supine position, can be misleading when planning a prone PCNL [3]. As such, only in these anecdotal cases of retrorenal colon, the surgeon can decide to go back to the prone position.…”

mentioning

confidence: 99%

Supine PCNL is the way to go!

Giusti

Proietti

2017

CEJU

View full text Add to dashboard Cite

Preoperative Planning with Noncontrast Computed Tomography in the Prone and Supine Position for Percutaneous Nephrolithotomy: A Practical Overview

Abstract: Supine NCCT is not accurate to plan PCNL access in prone position. Prone decubitus is associated with more potential organ injuries in the upper pole. In supine, the kidney situates deeper in the abdomen but the access angle is wider than in prone.

Cited by 22 publications

References 20 publications

New computed tomographic predictors of complicated perioperative course of 17.5F mini-percutaneous nephrolithotomy (mini-PNL)

New computed tomographic predictors of complicated perioperative course of 17.5F mini-percutaneous nephrolithotomy (mini-PNL)

Impact of patient position on the outcomes of percutaneous neprolithotomy for complex kidney stones

Supine PCNL is the way to go!

Contact Info

Product

Resources

About