Percutaneous nephrostomy in supine position.
BACKGROUND
Percutaneous nephrostomy has traditionally been performed with the patient in the prone position, probably to reduce the risk of injury to adjacent visceral organs, particularly the colon. The prone position, however, is associated with disadvantages such as patient discomfort and circulatory and ventilatory difficulties, particularly in obese patients. We describe a technique of percutaneous nephrostomy with the patient in the supine anterolateral position using local anesthesia, ultrasound-guided puncture, and fluoroscopy-controlled placement.


METHODS
The supine anterolateral position was obtained by placing towels under the ipsilateral shoulder and gluteus to elevate the flank approximately 30 degrees, thus providing enough space for ultrasound scanning and ultrasound-guided puncture of the collecting system. The ipsilateral arm was placed over the thorax, and the contralateral arm was used for intravenous perfusion. The ipsilateral leg was flexed slightly, and the contralateral leg was flexed and abducted so that its lateral aspect lay on the table, providing adequate space in case of concomitant transurethral manipulation. In this supine position, the colon falls anteromedially and thus well apart from the puncture paths. In contrast, in the prone position, it is pushed against the lateral surface of the kidney in the way of possible puncture paths.


CONCLUSIONS
Our experience with 12 consecutive patients showed this technique to be easy, safe, and effective and to prevent the discomfort and ventilation difficulties of the prone position, particularly in obese patients or those in poor general condition or with respiratory problems.
Cormio
Luigi
L
Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy. luigicormio@libero.it
Annese
Pasquale
P
Corvasce
Tommaso
T
De Siati
Mario
M
Turri
Francesco P
FP
Lorusso
Fabrizio
F
Pentimone
Salvatore
S
Perrone
Antonia
A
Carrieri
Giuseppe
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology; D011446:Prospective Studies; D016683:Supine Position; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler