Supine Percutaneous Nephrolithotomy in the Galdako-Modified Valdivia Position: A High-Volume Single Center Experience

Comparison of safety and efficacy of one shot dilation vs. gradual dilation technique in supine percutaneous nephrolithotomy

PURPOSE

To compare the efficacy and safety of gradual dilation (GD) and one-shot dilation (OSD) techniques in patients who underwent supine percutaneous nephrolithotomy (PCNL).

METHODS

The data of 176 patients who underwent supine PCNL were reviewed. Eighty-seven patients who underwent OSD were defined as group 1, and 89 patients who underwent GD were defined as group 2. Both surgical techniques were compared with each other in terms of various parameters. Then, regression analysis of factors predicting stone-free status and complications in patients who underwent supine PNL were performed. Then, regression analysis of factors predicting success rate and complications in patients who underwent supine PNL were performed.

RESULTS

No statistical difference was found in terms of stone-free rate, Clavien-Dindo complication grade and operation time. No statistical difference was found in terms of success rate, Clavien-Dindo complication grade and operation time. However, the fluoroscopy time was found to be significantly shorter in group 1 (p < 0.001). In the analysis of factors predicting stone-free status, the presence of calyceal stones, increased stone size and number were associated with a decrease in stone-free rate. In the analysis of factors predicting success, the presence of calyceal stones, increased stone size and number were associated with a decrease in success rate. Increased fluoroscopy and operation time, increased complication rates were found to be significantly associated with residual stone. Analysis of factors predicting complications found a higher complication rate in patients with low BMI and severe hydronephrosis. Increased complication was associated with increased time to nephrostomy removal and hospital stay, decrease in stone-free rate, decrease in Hb and increase in Cre value at the postoperative 24th hour.

CONCLUSION

When comparing OSD and GD in patients undergoing supine PCNL, both techniques have similar stone-free and complication rates. When comparing OSD and GD in patients undergoing supine PCNL, both techniques have similar success and complication rates. Compared to GD, the OSD technique can be preferred primarily due to its shorter fluoroscopy time.

Is supine position safe and effective for the percutaneous nephrolithotomy? Clinical experiences, tip and tricks in learning curve and PSAA technique

AIM

The aim of this study was to determine the factors facilitating the supine percutaneous nephrolithotomy technique in learning curve, to compare the supine and prone technique results.

MATERIAL AND METHODS

47 patients who required percutaneous nephrolithotomy were included in this study, and they were divided into two groups as supine and prone. Prone technique was performed to 24 patients in the first group. In the second group, the supine technique was performed by calculating the patient-specific access angle for 23 patients. Demographic, preoperative, intraoperative, postoperative parameters, transfusion, and complications of both groups were compared.

RESULTS

Age, gender, side, stone size, stone-free rate, and length of stay in hospital were not statistically significant between the groups. Operation and fluoroscopy time were lower in the supine group, but it was not statistically significant. The decrease in hemoglobin was higher in the supine group and it was statistically significant (p = 0.027). The decrease in hemoglobin was not symptomatic in both groups. In addition, transfusion rates were similar and not statistically significant.

DISCUSSION

In previous studies, the supine technique was evaluated in terms of many factors. Process steps were tried to be standardized and improvements were made in the access technique. The supine technique, which uses patient-specific access angle, has similar complication rates as the prone technique. However, the operation and fluoroscopy times are shorter than the prone technique. For surgeons on the learning curve, the supine technique is safe, feasible, and has even shorter operating times with a patient-specific access angle.

Factors Predicting Outcomes of Supine Percutaneous Nephrolithotomy: Large Single-Centre Experience

Objective: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large renal calculi. The prone position has been considered the preferred position to obtain renal access. However, the supine position has recently gained popularity, which confers several potential advantages. The current study analyses the prognostic factors for successful supine PCNL procedures in a larger tertiary centre. Subjects: Prospective data were collected from all patients undergoing PCNL in the Galdako modified Valdivia position at our institution between February-2007 and September-2020. Surgical outcomes variables collected included: the rate of Endoscopic-combined intra-renal surgery (ECIRS), operative times, surgical effectiveness (no residuals <2 mm stone fragments) and complications. Results: A total of 592 patients underwent PCNL with a median age of 56 years (IQR: 42−67). The median stone size was 17 mm (IQR: 13−23). Of those, 79% of patients had an effective procedure. Stone size (p < 0.001), location (p < 0.001) and Guys-Stone Score (GSS) (p < 0.001) were associated with effectiveness. A Percutaneous nephrostomy tube was sited at the completion of the procedure in 97.3% of patients and a simultaneous double-J stent in 45.3%. Stent insertion was associated with larger stones (p < 0.001), the performance of ECIRS (p < 0.001) and higher GSS (p < 0.001). The overall complication rate was 21.7%. The main type of complication was an infection in 26.2 of the cases followed by the need for repeated nephrostogram in 12.7%. Conclusions: We demonstrate that PCNL in a high-volume centre is safe and efficacious in the Galdalko modified Valdivia position. Patients with smaller stones in the renal pelvis and a low GSS have the highest chance of a successful procedure.

A new safe and ergonomic manipulation tool for the flank free supine position: 'U-Pad'

INTRODUCTION

One of the most important problems in the supine percutaneous approach to the kidney is the narrow surgical surface area (SSA) in the lumbar region. Herein, the spatial and angular geometric advantages of the U-shaped lumbar pad (U-Pad) used as a new positioning tool for safety and ergonomics in the supine percutaneous approach have been revealed.

MATERIALS AND METHODS

Data of patients who underwent endoscopic combined intrarenal surgery (ECIRS) using the U-Pad for kidney stones between March and September 2021 were prospectively collected. The demographic, preoperative, operative, and postoperative data of patients have been saved. The patients were positioned first with the standard gel pad (Group 1) and then with the U-Pad (Group 2). Both SSA (X and X+Y, cm2) and angular degree (α and β,0) calculations were compared. Fluoroscopy images with the same settings (97 kV/3.00 mA) were visually compared. In geometric data, trapezoidal area formula ((upper base+lower base) X height/2) and goniometer were used to compare with Paired t-test.

RESULTS

Endoscopic combined intrarenal surgery was performed on 17 patients, 13 men and, 4 women, with a median age of 39 (range 32-47). The median body mass index (BMI) was 26.2 (23.5-29.1). Stone localization and features were recorded. The median SSA was calculated as 35.7 cm2 in group 1 and 97.3 cm2 in group 2, and it was calculated that the total SSA increased to 272.5% with a median of 61.6 cm2 extra surgical area. Similarly, the downward manipulation angle was 320 (α0) in group 1, while it was 60.60 (β0) in group 2, and the median extra motion angle was calculated as 28.60 (89.3%).

CONCLUSION

The U-Pad is a safe and rapid tool in the supine percutaneous approach to the kidney, providing at least 2 times the extra SSA and manipulation angle.

Supine Percutaneous Nephrolithotomy in a Patient with Solitary Lung: A Case Report and Literature Review

Percutaneous nephrolithotomy (PNL) surgeries are performed with different patient positions, anesthesia methods and different-sized access sheaths in order to reduce the complication rates. Supine positioned PNL can be performed safely in the high-risk group patients with comorbidities. Herein, we present a patient who had a past surgical history of right pneumonectomy and underwent a supine PNL procedure under regional anesthesia for a staghorn renal stone in the right kidney.

Comparison of two different minimally invasive percutaneous nephrostomy sheaths for the treatment of staghorn stones

OBJECTIVE

To compare the safety and effectiveness of using a conventional nephrostomy sheath (NS) vs using a new NS with suction and evacuation functions in minimally invasive percutaneous nephrolithotomy (MPCNL) for the treatment of staghorn stones.

PATIENTS AND METHODS

A prospective and randomised study of 60 patients with staghorn stones randomly assigned into two groups of 30 patients. One group underwent MPCNL using conventional NS, whereas the other group underwent MPCNL with suction-evacuation NS (SENS). Patient demographics, stone characteristics, intraoperative data, perioperative data, and surgical results were collected and analysed.

RESULTS

The patient demographics and stone characteristics were similar amongst the two groups. The SENS group had a significantly lower peak and a significantly lower average renal pelvic pressure (RPP) throughout the procedure. The SENS group was more efficient for stone removal and had a much shorter stone treatment time, a lesser use of the stone extractor, and ultimately a higher stone-free rate (SFR). The effects of a lower RPP and shorter stone treatment time translated into less severe postoperative complications as measured per modified Clavien grade.

CONCLUSION

Using SENS in MPCNL for the treatment of staghorn stones has the advantages of lower RPP, increased effectiveness in stone retrieval, decreased surgery related complications, and an improved SFR.

Supine Percutaneous Nephrolithotripsy in Double-S Position

Background

At present, the percutaneous nephrolithotripsy (PCNL) is performed both in supine and in prone position. The aim of this paper is to describe an innovative position during PCNL.

Methods

We describe a supine position. The patient's legs are slightly abducted at the hips. The thorax is laterally tilted (inclination 30°–35°) and kept in the right position by one or two gel pads placed between the scapula and the vertebrae. External genitalia can be accessed at any time, so that it is always possible to use flexible instruments in the upper urinary tract. We used this position for a period of 12 months to treat with PCNL 45 patients with renal lithiasis.

Results

All the procedures were successfully completed without complications, using the position we are describing. The following are some of its benefits: an easier positioning of the patient; a better exposure of the flank for an easier access to the posterior renal calyces of the kidney; a lower risk of pressure injuries compared to positions foreseeing the use of knee crutches; the possibility of combined procedures (ECIRS) through the use of flexible instruments; and a good fluoroscopic visualization of the kidney not overlapped by the vertebrae.

Conclusions

This position is effective, safe, easy, and quick to prepare and allows for combined anterograde/retrograde operations.

Invited review: the tale of ECIRS (Endoscopic Combined IntraRenal Surgery) in the Galdakao-modified supine Valdivia position

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.