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Free-flank modified supine vs. prone position in percutaneous nephrolithotomy: A prospective randomised trial

View Article: PubMed Central

ABSTRACT

Objective: To compare the technical aspects, operative time, safety and effectiveness of percutaneous nephrolithotomy (PCNL) in the free-flank modified supine position (FFMSP) vs. the standard prone position (SPP).

Patients and methods: Seventy-seven patients (47 men and 30 women) with renal stones were enrolled and systematically randomised into two groups, A (39 patients) treated using the FFMSP, and B (38 patients) in the SPP. The outcome was considered as a cure (successful procedure) if the patient became stone-free or had residual fragments of <4 mm in diameter. The operative time (from the induction of anaesthesia to the removal of the endotracheal tube) was measured and any operative complications or conflicts were recorded. The different variables were compared and analysed between the groups.

Results: Patients in both groups had comparable preoperative clinical data and there were no significant differences in the preoperative clinical characteristics. The procedure was successful in 84.6% and 84% of group A and B, respectively. The operative time was significantly longer in group B (SPP) than A (FFMSP). There was no significant difference between the groups in fluoroscopy time and patients’ outcome.

Conclusions: The FFMSP (with a cushion under the ipsilateral shoulder) has similar efficacy and safety as the SPP for PCNL and is associated with a significantly quicker operation.

No MeSH data available.


(A, B) A patient in the FFMSP, with a water bag under his ipsilateral shoulder and his arm over the thorax.
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f0005: (A, B) A patient in the FFMSP, with a water bag under his ipsilateral shoulder and his arm over the thorax.

Mentions: With the patient supine, cystoscopy was performed and a 6 F open-tip ureteric catheter was introduced and fixed with plaster tape to the indwelling Foley catheter. In group A the patients were placed in the FFMSP by putting a suitable cushion (a 3-L water bag, or less according to body mass) under the ipsilateral shoulder, having the ipsilateral arm bent over the thorax, and extending and crossing the patient’s ipsilateral leg over the flexed contralateral leg (Fig. 1). This modification increased the distance between the last rib and iliac crest, and moving the cushion from under the flank (as in the original Valdivia position) to under the shoulder provided ample free flank space for the puncture, dilatation and manipulation of the stone. This manoeuvre also allowed easy access to the posterior calyx. In group B, the patients were turned prone (SPP) and renal access was achieved under fluoroscopic guidance through the posterior axillary line.


Free-flank modified supine vs. prone position in percutaneous nephrolithotomy: A prospective randomised trial
(A, B) A patient in the FFMSP, with a water bag under his ipsilateral shoulder and his arm over the thorax.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4442940&req=5

f0005: (A, B) A patient in the FFMSP, with a water bag under his ipsilateral shoulder and his arm over the thorax.
Mentions: With the patient supine, cystoscopy was performed and a 6 F open-tip ureteric catheter was introduced and fixed with plaster tape to the indwelling Foley catheter. In group A the patients were placed in the FFMSP by putting a suitable cushion (a 3-L water bag, or less according to body mass) under the ipsilateral shoulder, having the ipsilateral arm bent over the thorax, and extending and crossing the patient’s ipsilateral leg over the flexed contralateral leg (Fig. 1). This modification increased the distance between the last rib and iliac crest, and moving the cushion from under the flank (as in the original Valdivia position) to under the shoulder provided ample free flank space for the puncture, dilatation and manipulation of the stone. This manoeuvre also allowed easy access to the posterior calyx. In group B, the patients were turned prone (SPP) and renal access was achieved under fluoroscopic guidance through the posterior axillary line.

View Article: PubMed Central

ABSTRACT

Objective: To compare the technical aspects, operative time, safety and effectiveness of percutaneous nephrolithotomy (PCNL) in the free-flank modified supine position (FFMSP) vs. the standard prone position (SPP).

Patients and methods: Seventy-seven patients (47 men and 30 women) with renal stones were enrolled and systematically randomised into two groups, A (39 patients) treated using the FFMSP, and B (38 patients) in the SPP. The outcome was considered as a cure (successful procedure) if the patient became stone-free or had residual fragments of <4 mm in diameter. The operative time (from the induction of anaesthesia to the removal of the endotracheal tube) was measured and any operative complications or conflicts were recorded. The different variables were compared and analysed between the groups.

Results: Patients in both groups had comparable preoperative clinical data and there were no significant differences in the preoperative clinical characteristics. The procedure was successful in 84.6% and 84% of group A and B, respectively. The operative time was significantly longer in group B (SPP) than A (FFMSP). There was no significant difference between the groups in fluoroscopy time and patients’ outcome.

Conclusions: The FFMSP (with a cushion under the ipsilateral shoulder) has similar efficacy and safety as the SPP for PCNL and is associated with a significantly quicker operation.

No MeSH data available.