الفهرس 
AnatomyOnly 14 pages are availabe for public view
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Abstract
Percutaneous nephrolithotomy (PCNL) is the standard treatment for
patients with complex or large upper urinary tract stones. Because it
allows a large surface area for renal puncture, PCNL is routinely
performed in prone position, which can also provide a wide space for
instrument manipulation and avoid abdominal visceral injuries as much
as possible. However, it has some potential drawbacks, especially in
cardiac, obese and elderly patients. It may also increase the happening of
anesthesia complications (position-related circulatory and ventilator
difficulties) and be difficult for intraoperative reposition. In addition, this
position is also unsuitable for numerous patients with a skeletal
deformity.
For PCNL in supine position, not only does it overcome the
drawbacks by prone PCNL, but also provide some potential advantages.
For example, it can provide an opportunity for surgeons to
simultaneously perform PCNL and ureteroscopic procedures, save the
operation time of patient repositioning. However, disadvantages coexist,
such as it limits the space for renal puncture and it may be difficult for
manipulating the nephroscope. Considering the advantages and
limitations of these two positions, more and more controversies presented
focusing on how to choose the optimal position for PCNL. Though
several researches had compared supine with prone position for PCNL,
the results were still inconclusive.
The aim of this work was to study the safety and efficacy of supine
position in percutaneous nephrolithotomy compared to the standard prone
position. This Prospective randomized study for 60 patients admitted in
Menoufia University Hospital with renal stones planned for PCNL
operation during the period from November 2017 till May 2019.
Summary
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Patients with renal stones more than 2 cm included in the current studied
were divided into two groups as group A: included 30 patients subjected
to PCNL in the prone position. group B: included 30 patients subjected
to PCNL in the modified flank free supine position. Patients with
uncorrectable coagulopathy and active UTI including sepsis were
excluded from our study.
Results of the current study could be summarized as follow:
Mean age of the studied patients was 47.53± 8.30 years, most of
them were males (68.3%). Mean BMI was 31.88±7.41 kg/cm2. Most of
patients had stone pelvis (38.3%) followed by patients who had stone
pelvis and lower calyx (26.7%). Mean stone size 4.31± 1.38 cm and mean
Hounsfield unit was 947.72± 199.11.
There was statistically insignificant difference between prone and
Supine position regarding age, weight, height, body mass index, sex and
previous surgery (p>0.05).
Regarding site of stone, 36.67% of patients with prone position had
pelvis and lower calyx. While, 46.67% of patients with supine position
had pelvis stone.
There was no statistically significant difference between prone and
Supine positions regarding operative time (p>0.05).
Mean fluoroscopy time was 6.9 ± 2.4 min in prone position and 7.3
± 2.6 min in supine position, but there was no statistically significant
difference between prone and supine positions (p>0.05).
A shorter hospital stay in prone (45.60±14.23 hours), than in
supine position (48.60±19.84 hours) but the differences between them did
not reach a statistically significant level (p>0.05).
Size of stone was in range of 2.5-8 cm with mean 4.05±1.21 cm in
prone group and 2.7-8.1 with 4.56±1.51cm in supine group. Whereas,
Summary
109
there was no statistically significant difference between prone and Supine
position regarding size of stone and Hounsfield unit (p>0.05).
The auxiliary procedures reported in all patients with residual
stones. in prone group, all 3 patients (100%) underwent SWL While, in
supine group, 4 patients (66.7%) underwent SWL and the remaining 2
cases (33.3%) underwent 2nd look PCNL.
Mean size of residual stone were increased in supine position
(0.75±.31 cm) higher than in prone position (0.52±0.27cm). Also,
residual stones were observed among 3 patients (10%) with prone
position than 6 (20%) patients with supine position, with statistically
insignificant differences between them.
There was no statistically significant difference between prone and
Supine position regarding DROP of hemoglobin, need of blood transfusion,
stone free rate and hospital stay (p>0.05).
Fever occurred in 3.3% of cases in each group and urine leakage in
patient with prone group but with no statistically significant difference
(p>0.05). No blood transfusion needed in both groups.