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Tsaturyan A, Vrettos T, Ballesta Martinez B, Liourdi D, Lattarulo M, Liatsikos E, Kallidonis P. Position-related anesthesiologic considerations and surgical outcomes of prone percutaneous nephrolithotomy: a review of the current literature. Minerva Urol Nephrol 2022; 74:695-702. [PMID: 35622348 DOI: 10.23736/s2724-6051.22.04787-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The aim of the current study was to perform a critical review of existing literature and report the potential morbidity of patient positioning during urological surgeries as well as evaluate the surgical outcomes and anesthesiologic benefits and risks of prone percutaneous nephrolithotomy (PCNL). A narrative review of the current literature has been performed. Articles related to position-related injuries and complications under general anesthesia in prone positions were selected, studied, and considered for the current review. We found that under general anesthesia, the prone position improved the oxygenation of patients and increased the elimination of carbon dioxide. A potential risk for position-related anesthesiologic side effects was reported for longer spine surgeries in a prone position. The injuries and position-related side effects were extremely rare following prone PCNL since the mean duration of the procedure was significantly shorter than that of spine surgery. In conclusion, the prone PCNL remains the most often utilized and preferred approach globally with well-established success and complication rates. Clinical outcomes of prone PCNL do not demonstrate an increased rate of anesthesiologic complications compared to the supine approach. Standardization of turnover of the position, and reduction of the operative time warrant a faster and complication-free recovery.
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Affiliation(s)
| | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | | | - Despoina Liourdi
- Department of Urology, University of Patras, Patras, Greece.,Department of Internal Medicine, Ag. Andreas General Hospital of Patras, Patras, Greece
| | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece - .,Department of Urology, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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2
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Sadiq AS, Atallah W, Khusid J, Gupta M. The Surgical Technique of Mini Percutaneous Nephrolithotomy. J Endourol 2021; 35:S68-S74. [PMID: 34499550 DOI: 10.1089/end.2020.1080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The mini percutaneous nephrolithotomy (mini-PCNL) has become a versatile tool to remove kidney stones >2 cm, lower pole stones >1 cm, renal stones previously unresponsive to shockwave therapy or inaccessible by ureteroscopy (within a caliceal diverticulum), stones within complex urinary tracts (urinary diversions, transplanted kidney, and horseshoe kidneys), and large impacted proximal ureteral stones. After positioning in either the supine or prone position, a cystoscopy is performed to place an open-ended catheter, occlusion balloon, or Accordian device into the collecting system. A foley catheter is placed in the bladder. An ultrasound with a curvilinear probe is used to survey the kidney and guide access into the collecting system with an 18 g percutaneous needle. Once access is obtained, a small 0.5 cm skin incision is made and the percutaneous tract is dilated over a wire. A 16.5F metallic or self-dilating suctioning access sheath is positioned with fluoroscopic guidance. A 12F rigid mini-PCNL nephroscope is used to evaluate the collecting system. Once a calculus is observed, options for stone fragmentation include a lithotripter with ultrasonic and ballistic energy, or laser lithotripsy using holmium or thulium laser fibers. Flexible ureteroscopy can be considered to ensure clearance of the collecting system. A 6F ureteral stent can be placed in either a retrograde or antegrade approach for drainage. The tract is sealed using Surgiflo hemostatic matrix with thrombin. Guidelines for postoperative care and troubleshooting techniques for mini-PCNL are reviewed along with the surgical steps in the accompanying video (Supplementary Video S1). There are few randomized trials comparing mini-PCNL with standard PCNL and ureteroscopy. There is some evidence to suggest a difference in transfusion rates comparing mini- and standard PCNL, as well as differences in stone-free rates when comparing mini-PCNL with ureteroscopy for the treatment of lower pole stones.
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Affiliation(s)
- Areeba S Sadiq
- Department of Urology, The Mount Sinai Health System, New York, New York, USA
| | - William Atallah
- Department of Urology, The Mount Sinai Health System, New York, New York, USA
| | - Jonathan Khusid
- Department of Urology, The Mount Sinai Health System, New York, New York, USA
| | - Mantu Gupta
- Department of Urology, The Mount Sinai Health System, New York, New York, USA
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Carrion DM, Cansino JR, Quintana LM, Gómez Rivas J, Mainez Rodriguez JA, Pérez-Carral JR, Martínez-Piñeiro L. Prone percutaneous nephrolithotomy: its advantages and our technique for puncture. Transl Androl Urol 2018; 7:950-959. [PMID: 30505733 PMCID: PMC6256044 DOI: 10.21037/tau.2018.10.04] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Percutaneous nephrolithotomy (PCNL) is considered the treatment of choice for large urinary calculi and staghorn lithiasis. The approach for this surgery may be either supine or prone, and different access techniques are described in the literature with the use of ultrasound, fluoroscopy, or both combined. We believe that prone PCNL offers to the urologist key advantages, such as the possibility of puncturing anatomically abnormal urinary tracts, to perform multiple percutaneous tracts in the same kidney, experiencing the vacuum cleaner effect, ease of exploring the upper calyx through the inferior calyx, possibility to perform endoscopic combined intrarenal surgery (ECIRS) and bilateral simultaneous surgery, and to performed over local anesthesia. An adequate training for the endourologist should include both the prone and supine techniques for PCNL and to know which patient can benefit the most from each one.
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Affiliation(s)
- Diego M Carrion
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | - José Ramón Cansino
- Department of Urology, La Paz University Hospital, Madrid, Spain.,La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Luis M Quintana
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | - Juan Gómez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain.,La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
| | | | | | - Luis Martínez-Piñeiro
- Department of Urology, La Paz University Hospital, Madrid, Spain.,La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
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Mourmouris P, Berdempes M, Markopoulos T, Lazarou L, Tzelves L, Skolarikos A. Patient positioning during percutaneous nephrolithotomy: what is the current best practice? Res Rep Urol 2018; 10:189-193. [PMID: 30464930 PMCID: PMC6214409 DOI: 10.2147/rru.s174396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Percutaneous nephrolithotomy (PCNL) is the gold standard procedure for treatment of large stones and complex kidney disorders, but its morbidity remains the highest among stone treatment procedures. In pursuit of minimizing complication rates, surgeons have developed different variations of the classic prone position in which PCNL is usually performed; one among them is supine position. In this study, we review the literature and present all available evidence on different variations in positioning during PCNL, in an effort to identify if there is a position that can minimize the morbidity of this procedure.
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Affiliation(s)
- Panagiotis Mourmouris
- Second Department of Urology, Athens Medical School, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece,
| | - Marinos Berdempes
- Second Department of Urology, Athens Medical School, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece,
| | - Titos Markopoulos
- Second Department of Urology, Athens Medical School, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece,
| | - Lazaros Lazarou
- Second Department of Urology, Athens Medical School, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece,
| | - Lazaros Tzelves
- Second Department of Urology, Athens Medical School, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece,
| | - Andreas Skolarikos
- Second Department of Urology, Athens Medical School, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece,
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Sabler IM, Katafigiotis I, Gofrit ON, Duvdevani M. Present indications and techniques of percutaneous nephrolithotomy: What the future holds? Asian J Urol 2018; 5:287-294. [PMID: 30364501 PMCID: PMC6197369 DOI: 10.1016/j.ajur.2018.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 04/10/2018] [Accepted: 05/25/2018] [Indexed: 12/12/2022] Open
Abstract
The purpose of the review was to present the latest updates on percutaneous nephrolithotomy (PCNL) procedure in terms of indications and evolving techniques, and to identify the advantages and disadvantages of each modality. The data for this review were collected after a thorough PubMed search in core clinical journals in English language. The key words included “PCNL” and “PNL” in combination with “indications”, “techniques”, “review” and “miniaturized PCNL”. Publications relevant to the subject were retrieved and critically reviewed. Current European and American Urology Association Nephrolithiasis Guidelines were included as well. The indications for standard PCNL have been changed through the past decade. Despite evolution of the procedure, innovations and the development of new technical approaches, the indications for miniaturized PCNL have not been standardized yet. There is a need for well-constructed randomized trials to explore the indications, complications and results for each evolving approach. A continuous reduction of tract size is not the only revolution of the last years. There is constant ongoing interest in developing new efficient miniature instruments, intracorporeal lithotripters and sophisticated tract creation methods. We can summarize that, PCNL represents a valuable well-known tool in the field of endourology. We should be open minded to future changes in surgical approaches and technological improvements.
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Affiliation(s)
- Itay M Sabler
- Department of Urology, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Ioannis Katafigiotis
- Department of Urology, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Mordechai Duvdevani
- Department of Urology, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
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Invited review: the tale of ECIRS (Endoscopic Combined IntraRenal Surgery) in the Galdakao-modified supine Valdivia position. Urolithiasis 2017; 46:115-123. [PMID: 29189885 DOI: 10.1007/s00240-017-1015-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 11/11/2017] [Indexed: 12/13/2022]
Abstract
Modern-day percutaneous nephrolithotomy (PNL) has undergone considerable evolution, mainly driven by the improvement in access techniques, endoscopic instrumentation technology, lithotripsy devices and drainage management. The introduction of the supine and supine-modified positions is also part of this evolution, enabling comfortable and safe procedures from an anaesthesiological point of view, and an easy combined retrograde surgery [Endoscopic Combined IntraRenal Surgery (ECIRS)], allowing tailoring of the procedure on the patient, the dynamic anatomy of the collecting system and the urolithiasis. The conceptual value of ECIRS extends beyond the single diagnostic and active advantages due to the simultaneous contribution of the flexible retrograde ureteroscopy: the merit consists in the promotion of the versatile attitude of the urologist, and in the fulfillment of a personalized stone management. ECIRS has no pretensions of superiority, but for sure is a new safe and effective way of interpreting PNL, in the hands of an experienced surgical team.
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Wollin DA, Preminger GM. Percutaneous nephrolithotomy: complications and how to deal with them. Urolithiasis 2017; 46:87-97. [PMID: 29149365 DOI: 10.1007/s00240-017-1022-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 11/11/2017] [Indexed: 11/29/2022]
Abstract
Percutaneous nephrolithotomy is a common surgical treatment for large and complex stones within the intrarenal collecting system. A wide variety of complications can result from this procedure, including bleeding, injury to surrounding structures, infection, positioning-related injuries, thromboembolic disease, and even death. Knowledge of the different types of complications can be useful in order to prevent, diagnose, and treat these problems if they occur. This review describes the diversity of complications with the goal of improving their avoidance and treatment.
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Affiliation(s)
- Daniel A Wollin
- Comprehensive Kidney Stone Center, Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, 40 Duke Medicine Circle, Room 1573, White Zone, Durham, NC, 27710, USA.
| | - Glenn M Preminger
- Comprehensive Kidney Stone Center, Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, 40 Duke Medicine Circle, Room 1573, White Zone, Durham, NC, 27710, USA
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Patel RM, Okhunov Z, Clayman RV, Landman J. Prone Versus Supine Percutaneous Nephrolithotomy: What Is Your Position? Curr Urol Rep 2017; 18:26. [PMID: 28247328 DOI: 10.1007/s11934-017-0676-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Percutaneous nephrolithotomy (PCNL) is the gold standard surgical procedure for treating large, complex renal stones. Due to its challenging nature, PCNL has undergone many modifications in surgical technique, instruments, and also in patient positioning. Since the first inception of PCNL, prone position has been traditionally used. However, alternative positions have been proposed and assessed over the years. This is a comprehensive review on the latest developments related to positioning in the practice of PCNL. RECENT FINDINGS The prone position and its modifications are the most widely used positions for PCNL, but with the introduction of various supine positions, the optimal position has been up for debate. Recent meta-analysis has shown a superior stone-free rate in the prone position and comparable complication rates to the supine position. The advantage of ease of access to the urethra for simultaneous retrograde techniques in the supine position is also possible with modifications in the prone position such as the split-leg technique. Modern-day PCNL has transformed from an operation traditionally undertaken in the prone position to a procedure in which a prone or supine position may be employed; however, published data have not shown significant superiority of either approach.
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Affiliation(s)
- Roshan M Patel
- Department of Urology, University of California, Irvine, 333 City Boulevard West, Suite 2100, Orange, CA, 92868, USA.
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, 333 City Boulevard West, Suite 2100, Orange, CA, 92868, USA
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, 333 City Boulevard West, Suite 2100, Orange, CA, 92868, USA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, 333 City Boulevard West, Suite 2100, Orange, CA, 92868, USA
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Dauw CA, Borofsky MS, York N, Lingeman JE. Percutaneous Nephrolithotomy in the Superobese: A Comparison of Outcomes Based on Body Mass Index. J Endourol 2016; 30:987-91. [PMID: 27440484 DOI: 10.1089/end.2016.0437] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Percutaneous nephrolithotomy (PCNL) is considered the gold standard for treatment of large renal calculi. Although several investigators have examined the feasibility and outcomes associated with PCNL in obese patients, these studies have been limited by small sample size, lack of a comparator group, or few patients at body mass index (BMI) extremes. We thus compared outcomes of superobese (BMI >50) patients undergoing PCNL vs both an "overweight" and "ideal" cohort. METHODS We used a prospectively maintained database to identify ideal (BMI 18.5-25), overweight (BMI 25.1-49.9), and superobese (BMI ≥50) patients who underwent PCNL. Our primary objective was to compare surgical outcomes between groups measured by the percent of patients who required secondary PCNL. We then compared complication rates, need for transfusion, and length of stay (LOS) using chi-square testing and ANOVA where appropriate. RESULTS A total of 1152 patients were identified of which 254 were classified as ideal, 840 as overweight, and 58 as superobese. The overweight cohort had a higher mean age and greater proportion of males, whereas staghorn stones were more common in the superobese group. Comorbid conditions were more commonly observed in the superobese cohort. Otherwise, the groups were similar. Surgical outcomes were comparable with 47.2%, 42.0%, and 38.0% of ideal, overweight, and superobese patients requiring secondary PCNL (p = 0.25) with no difference in complication rates, need for transfusion, or LOS. CONCLUSION PCNL can be effectively and safely performed in superobese patients with no difference in surgical outcomes or complications when compared to ideal or overweight patient cohorts.
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Affiliation(s)
- Casey A Dauw
- Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Michael S Borofsky
- Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Nadya York
- Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - James E Lingeman
- Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
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Ghani KR, Andonian S, Bultitude M, Desai M, Giusti G, Okhunov Z, Preminger GM, de la Rosette J. Percutaneous Nephrolithotomy: Update, Trends, and Future Directions. Eur Urol 2016; 70:382-96. [DOI: 10.1016/j.eururo.2016.01.047] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/28/2016] [Indexed: 12/24/2022]
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