The Split-leg Modified Lateral Position for Percutaneous Renal Surgery and Optimal Retrograde Access to the Upper Urinary Tract

Lezrek, M.; Ammani, A.; Bazine, K.; Assebane, M.; Kasmaoui, E.H.; Qarro, A.; Beddouch, A.; Alami, M.

doi:10.1016/j.urology.2011.03.012

Cited by 25 publications

(11 citation statements)

References 9 publications

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“…Percutaneous access guided by fluoroscopy can be challenging. A similar position with the legs bent in a lower position was described recently [23] .…”

Section: Lateral Positionsmentioning

confidence: 63%

Positions for percutaneous nephrolithotomy: Thirty-five years of evolution

Karaolides

Moraitis

Bach

et al. 2012

Arab Journal of Urology

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ObjectivesTo present the chronological development of the different positions described for percutaneous nephrolithotomy (PCNL), in an attempt to identify the reasons for their development and to highlight their specific advantages and disadvantages.MethodsPrevious reports were identified by a non-systematic search of Medline and Scopus.ResultsThe classic prone position for PCNL was first described in 1976. The technique was gradually standardised and PCNL with the patient prone became the generally accepted standard approach. In the next 35 years many other positions were described, with the patient placed prone, lateral or supine in various modifications. Modifications of the classic prone position in the early 1990s aimed to provide the option of a simultaneous retrograde approach during the procedure. As PCNL became more popular the lateral position was first described in 1994, to allow the application of PCNL to patients who were unable to tolerate being prone because of their body habitus. The supine position for percutaneous access was originally described even before 1990, but become more popular after 2007 when the Galdakao modification was reported. Several other modifications of the supine position have been described, with the latest being the flank-free modified supine position, which allows the best exposure of the flank among the supine positions. Each position has its specific advantages and disadvantages.ConclusionUrologists who perform PCNL should be familiar with the differences in the positions and be able to use the method appropriate to each case.

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“…Percutaneous access guided by fluoroscopy can be challenging. A similar position with the legs bent in a lower position was described recently [23] .…”

Section: Lateral Positionsmentioning

confidence: 63%

Positions for percutaneous nephrolithotomy: Thirty-five years of evolution

Karaolides

Moraitis

Bach

et al. 2012

Arab Journal of Urology

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“…[34] Although open ureterolithotomy for patients with proximal ureteral stones had a median stone-free rate of 97%, it not recommended as a first-line treatment, because of longer hospitalization and greater post-operative morbidity. [3578] In the era of modern endourology, most ureteral stones can be treated with ureteroscopy or SWL. Actually, SWL for the treatment of large stones >20 mm has a reported stone-free rate of 45% to 60%.…”

Section: Discussionmentioning

confidence: 99%

“…[5] Briefly, Perc-URS is performed under general anesthesia and the patient is placed in the lateral modified position, with all pressure points padded. Initially, the thorax is tied up with Elastoplasts band in the lateral position perpendicular to the operating table.…”

Section: Methodsmentioning

confidence: 99%

Large impacted upper ureteral calculi: A comparative study between retrograde ureterolithotripsy and percutaneous antegrade ureterolithotripsy in the modified lateral position

et al. 2013

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Context:The treatment for patients with large impacted proximal ureteral stone remains controversial, especially at institutions with limited resources.Aim:The aim of this study is to compare and to evaluate the outcome and complications of two main treatment procedures for impacted proximal ureteral calculi, retrograde ureterolithotripsy (URS), and percutaneous antegrade ureterolithotripsy (Perc-URS).Settings and Design:Our inclusion criteria were solitary, radiopaque calculi, >15 mm in size in a functioning renal unit. Only those patients in whom the attempt at passing a guidewire or catheter beyond the calculus failed were included in this study.Patients and Methods:Between January 2007 and July 2011, a total of 52 patients (13 women and 39 men) with large impacted upper-ureteral calculi >15 mm and meeting the inclusion criteria were selected. Of these, Perc-URS was done in 22 patients (group 1) while retrograde ureteroscopy was performed in 30 patients (group 2). We analyzed operative time, incidence of complications during and after surgery, the number of postoperative recovery days, median total costs associated per patient per procedure, and the stone-free rate immediately after 5 days and after 1 month.Statistical Analysis Used:Bivariate analysis used the Student t-test and the Mann-Whitney test to compare two means and Chi-square and Fisher's exact tests to compare two percentages. The significance level was set at 0.05.Results:The mean age was 42.3 years (range 22-69). The mean stone sizes (mm) were 34 ± 1.2 and 29.3 ± 1.8 mm in group 1 and 2, respectively. In the Perc-URS group, 21 patients (95.45%) had complete calculus clearance through a single tract in one session of percutaneous surgery, whereas in the URS group, only 20 patients (66.7%) had complete stone clearance (P = 0.007). The mean operative time was higher in the Perc-URS group compared to group 2 (66.5 ± 21.7 vs. 52.13 ± 17.3 min, respectively; P = 0.013). Complications encountered in group 1 included transient postoperative fever (2 pts) and simple urine outflow (2 pts). Ten patients (33%) of group 2 experienced failure: Migration to the kidney (3 pts), ureteral perforation (2 pts), tortuosity of the ureter (2 pts), and epithelial polyps (2 patients). Group 1 patients had an average visual analog (VAS) pain score of 47 mm compared with 31 mm in group 2 patients. The mean hospital stay (days) in group 1 was higher than the group 2 (2.27 ± 0.8 vs. 1.67 ± 0.6, respectively; P = 0.01). The mean analgesia requirement for group 1 (paracetamol chlorhydrate + codeine 12 ± 3 g) was significantly more compared with group B (6.8 ± 2 g) (P < 0.01). The difference in average blood loss between the two groups was not statistically significant. Total costs was slightly higher in group 1 but the difference was not statistically significant between the two groups (15000 vs. 13400 MDH respectively; P > 0.05). After 1 month, the stone free-rate remained higher in group 1 (95.5% vs. 66.7%, respectively; P = 0.012).Conclusions:In our series, Perc-URS is a saf...

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“…PCNL can be done in prone, prone-flexed, supine, supine oblique, and split-leg modified lateral positions. [1523242526] The advantages of the prone position are significantly shorter nephrostomy tract length and potentially greater access sites. Simultaneous antegrade and retrograde upper urinary tract access is the advantage of supine and lateral positions, but renal access in these positions is usually achieved under ultrasonographic guidance.…”

Section: Effect Of Patient Position and Site Of Access On Renal Accesmentioning

confidence: 99%

The ideal puncture approach for PCNL: Fluoroscopy, ultrasound or endoscopy?

Lojanapiwat

2013

Indian J Urol

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Percutaneous renal access is a common procedure in urologic practice. The main indications are drainage of an obstructed and hydronephrotic kidney and antegrade renal access prior to percutaneous renal surgeries such as percutaneous nephrolithotomy (PCNL) and percutaneous endopyelotomy (EP). The contraindications for this technique are patients with history of allergy to topical or local anesthesia and patients with coagulopathy. The creation of a percutaneous tract into the renal collecting system is one of the important steps for percutaneous renal access. This step usually requires imaging.The advantages and disadvantages of each modality of image guidance are controversial. We performed a structured review using the terms: Percutaneous nephrostomy, guidance, fluoroscopy, ultrasonography, computed tomography (CT) scan, and magnetic resonance imaging (MRI). The outcomes are discussed.

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The Split-leg Modified Lateral Position for Percutaneous Renal Surgery and Optimal Retrograde Access to the Upper Urinary Tract

Cited by 25 publications

References 9 publications

Positions for percutaneous nephrolithotomy: Thirty-five years of evolution

Positions for percutaneous nephrolithotomy: Thirty-five years of evolution

Large impacted upper ureteral calculi: A comparative study between retrograde ureterolithotripsy and percutaneous antegrade ureterolithotripsy in the modified lateral position

The ideal puncture approach for PCNL: Fluoroscopy, ultrasound or endoscopy?

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