Comparison of Supine and Prone Positions in PCNL Operations Performed in Isolated Kidney Upper Pole Access

Abstract

Background: Renal stones larger than 2 cm in the upper pelvical system are usually managed with Percutaneous Nephro-lithotomy (PCNL) operation, but there are unclear as to which position should be used. In our study, we aimed to compare the preoperative-peroperative and postoperative data of patients who underwent PCNL with isolated renal upper pole access in supine and prone position. Materials and Methods: The study included 20 Supine PCNL and 45 Prone PCNL cases who underwent isolated renal upper pole access for renal calculi. Age, gender, body mass index (BMI) were evaluated from demographic data. Radiological findings such as stone-skin distance, stone density, stone size and volume were recorded. Total operation time, access time and fluoroscopy time were recorded from peroperative data. In the postoperative period, the duration of hospital stay and complications according to Clavien Dindo classification were recorded. Non-contrast computed tomography was performed at the 1st postoperative month and the stone-free status of the patients was evaluated. Results: There was no statistical difference in demographic data in terms of age, gender, BMI, ASA scores in both groups. The total operation time was 75.95±28.7 min in supine PCNL group and 92.48±23.4 min in prone PCNL group (p<0.001). Access time was 11.6±5.12 min in supine PCNL group and 9.2±3.7 min in prone PCNL group (p<0.001). Fluoroscopy time was 3.6±1.2 min in the supine PCNL group and 2.5±1.1 min in the prone PCNL group and was statistically longer (p<0.001). There was no difference in complications between the groups. Grade>2 complications according to Clavien Dindo classification were more frequent in supine PCNL patients (p:0.03). Stone-free status was 70% in supine PCNL patients and 77.7% in prone PCNL patients and was higher in the prone PCNL group (p:0.01). Conclusions: In patients undergoing PCNL for isolated upper pol stone, the operation time is longer when prone PCNL is performed, but higher stone-free rates are obtained in these patients. Grade >2 complications are less common in prone PCNL for renal upper pole calculi.

Keywords

• PCNL
• supine position
• prone position
• renal calculi
• stone surgery

İzole Böbrek Üst Pol Akses Yapılan PCNL Operasyonlarında Supin ve Prone Pozisyonlarının Karşılaştırılmas

Abstract

Amaç: Üst pelvikalsiyel sistemde 2 cm’den büyük böbrek taşları genellikle Perkütan Nefrolitotomi (PCNL) operasyonu ile tedavi edilir ancak hangi pozisyonda olması gerektiği konusunda belirsizlikler vardır. Çalışmamızda supin ve prone pozisyonunda izole böbrek üst pol aksesi ile PCNL yapılan hastaların preoperatif-peroperatif ve postoperatif verilerinin karşılaştırılması amaçlanmıştır. Materyal-Method: Çalışmaya böbrek üst polüne akses yapılan 20 Supin PCNL ve 45 Prone PCNL vakası dahil edildi. Hastaların demografik verileri, preoperatif bulguları, peroperatif verileri, postoperatif komplikasyon oranları ve operasyondan 1 ay sonra çekilen Non-Kontrast Bilgisayarlı Tomografi ile taşsızlık durumu değerlendirildi. Bulgular: Her iki grupta demografik verilerden yaş, cinsiyet, VKİ, ASA skorları açısından herhangi bir istatistiksel fark izlenmedi. Peroperaif verilerden operasyon süresi supin PCNL grubunda 75.95±28.7 dk, prone PCNL grubunda 92.48±23.4 dk olup daha kısaydı (p<0.001). Akses ve floroskopi süresi ise Supin PCNL grubunda (11.6±5.12 dk ve 3.6±1.2 dk) prone PCNL’ye (9.2±3.7 dk ve 2.5±1.1 dk) göre istatistiksel olarak daha uzundu (p<0.001). Gruplar arasında komplikasyonlar açısından fark izlenmedi. Grade>2 komplikasyonlar Supin PCNL hastalarında daha sıktı (p:0.03). Taşsızlık açısından supin PCNL hastalarında %70, prone PNCL hastalarında %77.7 izlendi (p:0.01). Sonuç: Üst pole akses ile yapılan PCNL operasyonlarında prone PCNL’de daha uzun operasyon süresi olsa da daha yüksek taşsızlık sağlanmaktadır. Prone PCNL’de Grade >2 komplikasyonlar daha az görülmektedir

Keywords

• PCNL
• supin pozisyon
• prone pozisyon
• böbrek taşı
• taş cerrahisi

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