Comparative study of percutaneous nephrolithotomy performed in the traditional prone position and in three different supine positions

Vol. 44 (x): 2018 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0191


ORIGINAL ARTICLE

Petronio Augusto de Souza Melo 1, Fabio Carvalho Vicentini 1, Rodrigo Perrella 1, Claudio Bovolenta Murta 1, Joaquim Francisco de Almeida Claro 1
1 Divisão de Urologia do Centro de Saúde Masculina do Hospital Brigadeiro, São Paulo, SP, Brasil

ABSTRACT

Purpose: To compare the outcomes of percutaneous nephrolithotomy (PCNL) performed in the prone position (PRON) and in three variations of the supine position.

Materials and Methods: We performed a retrospective analysis of patients that underwent PCNL at our institution from June 2011 to October 2016 in PRON and in three variations of the supine position: complete supine (COMPSUP), original Valdivia (VALD), and Galdakao – modified Valdivia (GALD). All patients had a complete pre – operative evaluation, including computed tomography (CT). Success was defined as the absence of residual fragments larger than 4 mm on the first post – operative day CT.

Results: We analyzed 393 PCNLs: 100 in COMPSUP, 94 in VALD, 100 in GALD, and 99 in PRON. The overall success rate was 50.9% and was similar among groups (p = 0.428). There were no differences between groups in the number of punctures, stone – free rate, frequency of blood transfusions, drop in hemoglobin level, length of hospital stay, and severe complications (Clavien ≥ 3). COMPSUP had a significantly lower oper­ative time than the other positions. COMPSUP had lower fluoroscopy time than VALD.

Conclusion: Patient positioning in PCNL does not seem to impact the rates of success or severe complications. However, COMPSUP is associated with a shorter surgical time than the other positions.

Keywords: Nephrolithotomy, Percutaneous; Prone Position; Kidney Calculi

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