Percutaneous nephrolithotomy in semisupine position: a modified approach for renal calculus |
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Authors: | Ke-wei Xu Jian Huang Zheng-hui Guo Tian-xin Lin Cai-xai Zhang Hao Liu Jian Chun You-sheng Yao Jin-li Han Hai Huang |
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Institution: | (1) Department of Urology, The Memorial Hospital of Sun Yat-Sen University, Guangzhou, 510120, China; |
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Abstract: | Conventional percutaneous nephrolithotomy (PCNL) is usually performed in a prone position, which compresses the thorax and
results in difficulty in rescue during operation. When PCNL is performed in a supine position, the flank renal puncture area
is limited, so it is difficult to treat disseminated and complex renal calculi. Herein, we introduce a modified semisupine
position for performing PCNL, which has numerous benefits as well as safe and effective. Between May 2002 and May 2009, a
total of 452 patients with renal calculi were treated with semisupine PCNL. The patient was placed in 45° semisupine position
during the procedure, with the affected flank arched as much as possible. In this series, no one converted to open surgery.
The average operating time was (115.2 ± 44.5) min. Single tract PCNL was performed for 80.97% of the cases, two tracts 13.94%,
three tracts 4.65%, and four tracts 0.44%. The upper, middle, and lower calix tracts accounted for 12.1, 63.0, and 24.9%,
of procedures, respectively. Stone-free rate was 85.7% overall, 92.2% for single calculus (83/90), and 72.9% for staghorn
calculi (78/107). Major postoperative complications occurred in 3.3% of the cases. This study demonstrated PCNL in a semisupine
position is an effective alternative for treating renal calculi, which combines the advantages of PCNL in a prone position,
and PCNL in a supine position. The semisupine position allows easier irrigation of stone fragments, is more comfortable for
the patient, and facilitates monitoring of anesthesia. |
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