Abstract

Objective: Due to some disadvantages of prone position, which is the most preferred approach in percutaneous nephrolithotomy (PCNL), supine PCNL has been described. In this study, we aimed to present the outcome of PCNL applied in supine position in our clinic.

Materials and methods: Between April 2010 and January 2011, 29 supine PCNL operations were performed on 29 renal units in our clinic. All the patients had primary renal stones without history of open or percutaneous surgery. The patients were evaluated by intravenous pyelography or computed tomography. At the begining of the procedure, renal pillows were located under the ipsilateral side, and ureteral catheters were placed in lithotomy position. Posterior axillary line was marked and never passed through anterior of this line during the renal access. Ultrasonographic access was done in first 6 cases, and then scopic access was performed to other 23 cases. Amplatz dilatators were used on 9 patients and balloon dilatators on 20 patients. The stones were broken with ultrasonographic and pneumautic lithotripsy by using 26F nephroscope, and then fragments were taken out. 

Results: Residual stones (≥4 mm) were detected in 5 patients, and 24 procedures were ended as stone-free (82%). Only one access was performed in all patients. In 5 patients who were without bleeding and extravasation, and who were stone-free (17%); the procedure was completed as tubeless by placing retrograde 6F double-J catheter. Mean hospitalization time was 3.1 days (range 1-5 days). Mean operating time was 64 min (range 25-130 min). Postoperative fever was developed in 3 patients. Double-J catheter was placed in a patient at postoperative 5th day because of prolonged urine leakage. No other surgical and anesthetic complication was detected.

Conclusion: Supine approach of the PCNL can be preferred in terms of patient comfort, allowing retrograde manipulations, and acceptable anesthetic risks. This position has similar success and complication rates with prone PCNL.