Modified Supine Percutaneous Nephrolithotomy for Large Kidney and Ureteral Stones: Technique and Results

BackgroundPercutaneous nephrolithotomy (PCNL) is the standard treatment for kidney stones >2 cm. Recently, a novel approach in the modified supine lithotomy position has been developed.ObjectiveTo demonstrate with a video our technique of supine PCNL (sPCNL) and present our experience.Design, setting, and participantsFrom September 2009 to August 2010, 47 consecutive patients were prospectively evaluated. There were 31 single, 9 multiple, and 7 staghorn stones. The mean body mass index was 26.1 ± 5 (range: 17.3–45.7), the mean stone size was 29.6 ± 15.3 mm (range: 10–75), and patients’ American Society of Anesthesiologists scores were 1, 2, and 3 in 31, 11, and 5 cases, respectively.Surgical procedurePatients were positioned in Galdakao-modified supine Valdivia position. The details of the technique are shown in the film.MeasurementsSuccess was defined as patients free of stones or with residual stone fragments <4 mm.Results and limitationsAverage operative room occupation time was 123.5 ± 51.2 min (range: 50–245). In the single, multiple, and staghorn stone groups, the immediate success rate after sPCNL was 90%, 78%, and 43%, respectively. Complications included one fever, two incidents of pyelonephritis, one renal colic, two urinary fistulae, one postoperative hemorrhage, and one incident of acute urinary retention. Mean hospital stay was 3.4 ± 1.9 d (range: 2–12). Nine patients (19%) had a secondary procedure (extracorporeal shock wave lithotripsy or flexible ureterorenoscopy). At 3 mo, the success rate was 97%, 100%, and 100% in the single, multiple, and staghorn stone groups, respectively. However, the limitation of this study is its design, which is descriptive rather than comparative.ConclusionssPCNL is a safe and reproducible method. It offers the advantage of simultaneous retrograde and antegrade endoscopic combined intrarenal surgery, and we believe it is a further advancement in stone management. In addition, it is easier from the anesthetist point of view than the traditional prone approach. In our hands, it meant a simplification of the operative technique, resulting in a more time-efficient procedure.