Why is Percutaneous Nephroscopy Still Performed with the Patient Prone?*

Valdivia, J. G.; Valer, Javier; Villarroya, Serafín; López, José Antonio López; Bayo, Angel; Lanchares, Emilio; Rubio, E. Abellán

doi:10.1089/end.1990.4.269

Cited by 55 publications

(24 citation statements)

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“…[8] Valdivia et al, [9] effectively demonstrated that elevation of the desired flank in the supine position enables safe PCNL with low risk of colon injury. In this study sample, PCNL was performed in 120 patients without the use of a nephrostomy tube; only a ureteric catheter was inserted for 24 hrs.…”

Section: Discussionmentioning

confidence: 99%

Tubeless PNL in the supine position

Wahab¹,

Sherif²,

El-Karamany³

2012

Turkish Journal of Urology

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Objective: To evaluate the safety, feasibility and efficacy of tubeless percutaneous nephrolithotomy (PNL) in a supine position in selected cases with renal stones. Materials and methods:This descriptive study enrolled 120 patients who presented to the urology department at Benha Faculty of Medicine with renal stones between June 2009 and June 2010. All patients were evaluated based on their history, a physical examination, kidney, ureter, bladder (KUB), pelviabdominal U/S and spiral CT of the abdomen and pelvis without contrast or IVP in selected cases. The patients were followed up for postoperative pain, leakage and fever. Perinephric collection with ultrasound (U/S) was performed, and the Hb% and hematocrit were determined after 12 hours. Results:The access to the stones was achieved through the lower calyx (70.8%) and middle calyx (29.2%) with a stone clearance rate of 100%, and there was no need for a 2nd session. The mean operative time was (67.1±19.2 min.), and the mean length of the hospital stay was (3.4±1.7 days). Three cases had perinephric collections <100 cc, which were managed conservatively and resolved within one week. Prolonged leakage occurred in three cases and also resolved spontaneously within five days. Three cases required a one-unit blood transfusion postoperatively. Stone-free status was achieved in all cases through the use of either the lower or middle calyx in the supine position during the operation. A single dose of non-steroidal antiinflammatory drugs (NSAID) was needed in 30 cases for postoperative analgesia. Conclusion:Tubeless PNL with the patients in the supine position can be used in selected cases with a favorable outcome and minimal morbidity with the potential advantage of deceases in the postoperative pain, analgesia requirement and hospital stay.Key words: Percutaneous nephrolithotomy; percutaneous nephrostomy; renal stones; tubeless PNL. ÖZETAmaç: Böbrek taşları olan seçilmiş olgularda sırt üstü pozisyonda tüpsüz PNL'nin güvenilirliği, uygulanabilirliği ve etkinliğini değerlendirmek. Gereç ve yöntem: Bu tanımlayıcı çalışmaya Haziran 2009-Haziran 2010 tarihleri arasındaki dönemdeBenha Tıp Fakültesi üroloji bölümüne böbrek taşı ile başvuran 120 hasta alındı. Hastaların tamamı öykü, fizik muayene, DÜS grafisi, pelviabdominal USG, abdomen ve pelvisin kontrastsız spiral BT'si veya seçilmiş olgularda IVP ile değerlendirildi. Hastalar ameliyat sonrası ağrı, sızıntı, ateş, USG ile perinefrik birikim açısından izlendi, %Hb ve hematokrit 12 saat sonra yapıldı. Bulgular: Taşa erişim alt kaliks (%70.8) ve orta kaliks (%29.2) yoluyla yapıldı, taş temizlenme oranı %100'dü. İkinci bir seansa gerek duyulmadı. Ortalama işlem süresi 67.1±19.2 ve ortalama hastanede kalış 3.4±1.7 idi. Üç olguda konservatif olarak tedavi edilen ve bir hafta içinde düzelen <100 cc perinefrik birikim vardı. Üç olguda uzamış sızıntı görüldü, bunlar da beş gün içinde kendiliğinden düzeldi. Üç olguda ameliyat sonrası bir ünite kan transfüzyonu gerekti. Bütün olgularda sırt üstü pozisyonunda alt veya orta...

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Section: Discussionmentioning

confidence: 99%

Tubeless PNL in the supine position

Wahab¹,

Sherif²,

El-Karamany³

2012

Turkish Journal of Urology

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“…Various safe and effective modifications of patient positioning for PCNL have been proposed, including the prone split‐leg position, which Scarpa et al. used some years ago, the reverse lithotomy position, the lateral decubitus, and the supine positions [7–9,19–25]. In 1987 Valdivia‐Urìa described a PCNL with the patient supine, with a 3‐L serum bag below the flank.…”

Section: Introductionmentioning

confidence: 99%

“…In 1987 Valdivia‐Urìa described a PCNL with the patient supine, with a 3‐L serum bag below the flank. Ten years later he reported 557 consecutive percutaneous nephroscopies performed in this way [23,24]. Surgical and anaesthesiological advantages were described, but despite this the technique has not become popular and remains a complementary method.…”

Section: Introductionmentioning

confidence: 99%

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Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access

Ibarluzea,

Scoffone,

Cracco

et al. 2007

BJU International

262

122

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“…It is the responsibility of the urologist to decide which technique is suitable for each patient and select between prone or supine position, taking into consideration the surgeon's experience and certain patient characteristics such as obesity, horseshoe kidney and others. Valdivia et al [6][7][8][9] first described the performance of percutaneous renal surgery in the supine position. This approach was modified years later by Ibarlucea et al [10,11,12].…”

Section: Evidence Acquisitionmentioning

confidence: 99%

Performing easy prone punction

2017

CEJU

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Introduction Percutaneous renal surgery has been considered one of the most important advances in urology. There are several possibilities to perform a kidney puncture such as using fluoroscopy, ultrasound or both. The aim of this article is to describe our puncture technique. Material and methods Correct puncture is one of the most critical and challenging steps during percutaneous surgery. Bull's eye technique and other similar techniques supported by fluoroscopy try to make triangulations and provide different views. On the other hand, many urologists prefer the usage of ultrasound to help reach the calyx. The perfect puncture could also be a scanner guided puncture. Results Under general anesthesia, cystoscopy is performed for ureteral catheter placement. The excretory system is opacified by administering contrast to the ureteral catheter. Perpendicular puncture on the selected calyx is done; this is a 90° puncture with a fine spinal needle 20G into the selected calyx under fluoroscopy control to visualize the correct penetration into the calyx. Moving forward to the next step, an 18G needle is used to follow the correct calyx -infundibulum -renal pelvis path. The goal is to put together both tips of the 2 needles (needle Kiss technique). Conclusions After several years of performing percutaneous surgery, we conclude that our technique can facilitate the prone position puncture thanks to the information given from the thin needle while simultaneously minimizing the use of fluoroscopy for triangulation maneuvers and avoiding the use of ultrasound to determine the depth of the target calyx.

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Why is Percutaneous Nephroscopy Still Performed with the Patient Prone?*

Cited by 55 publications

References 1 publication

Tubeless PNL in the supine position

Tubeless PNL in the supine position

Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access

Performing easy prone punction

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