Munich, Germany (UroToday.com) Prone position for percutaneous nephrolithotomy (PCNL) is a currently used in 80% of the world. There are many debates whether between the two positions, prone and supine. One of the limitations of supine positioning historically has been known that obtaining access in upper pole is extremely challenging due to the positioning of the patient during the supine PCNL. Authors in the study evaluated the feasibility, safety and efficacy of upper pole supracostal access in patients undergoing PCNL in a supine position.
A total of 51 patients were included in the study. Majority of these patients had upper calyceal stones (41%) and staghorn stones (24%). Upper pole access was obtained with patients with supine oblique positioning using a long 30cm rigid nephroscope. Main puncture is made at the suprocoastal location around the posterior axillary line under the fluoroscopy and ultrasound imaging. All patients received either ultrasonography or abdominal x-ray in postoperative day 1 to check for potential complications and bleeding following the procedure.
Dr. Al-Dessoukey reported that they were able to obtain access in all patients using the supracoastal access with patients with supine positioning. He stated “in the hand of an experienced surgeon, supracostal access with patients in supine positioning is feasible and safe”. Interestingly, authors reported that 26 patients (51%) the access was via 11th intercostal space, in 16 patients (31.4%) the access was via 10thintercostal space and in 9 patients (17.6%) the access was via 9th intercostal space.
Only 5.9% patients required second session procedure out of all 41% upper calyx and staghorn stones. Only 3 patients were required blood transfusion afer significant bleeding. No major, abdominal or thoracic injuries were reported.
Authors concluded that “following the basic principles of performing the supracostal puncture in full expiration, using working sheath, and achieving renal drainage helps to minimizing complications”.
Presented By:
Al-Dessoukey A.
Beni Suef University, Dept. of Urology, Cairo, Egypt
Reported by
Zhamshid Okhunov, MD, at the 31st Annual EAU Congress - March 12 - 15, 2016 – Munich, Germany
UC Irvine Urology