title: Percutaneous nephrolithotripsy with the patient in a modified supine position.
abstract: OBJECTIVE
  The supine position has potential advantages over the prone position for percutaneous nephrolithotripsy but it is neglected by most urologists. We analyzed the efficacy and safety of percutaneous nephrolithotripsy with the patient in a modified supine position.
  
  
  METHODS
  In a prospective study 88 consecutive patients underwent percutaneous nephrolithotripsy in a modified supine position. Mean+/-SD stone size was 3.6+/-1.9 cm and 26 patients (29.5%) had complete staghorn stones. Ten patients (11.4%) also had ureteral stones and underwent concomitant ureteroscopy. Complications and success rates were analyzed.
  
  
  RESULTS
  The lower, middle and upper calix was the only access in 42 (47.7%), 10 (11.4%) and 5 patients (5.7%), respectively. Four patients (4.5%) had supracostal access. A single percutaneous nephrolithotripsy session was needed in 78 patients (88.6%), while 10 (11.4%) required 2 sessions. A total of 62 patients (70.5%) were stone-free. Five patients (5.7%) required blood transfusion. Postoperative complications included ureteral obstruction due to migration of stones in 3 cases (3.4%), serious bleeding requiring arterial embolization in 2 (2.3%) and prolonged fever in 4 (4.5%). The need for direct access to the upper pole and the need for concomitant ureteroscopy did not affect the success and complication rates of percutaneous nephrolithotripsy. The colon was never damaged and we had no cases of hydrothorax, kidney loss or sepsis.
  
  
  CONCLUSIONS
  Percutaneous nephrolithotripsy with the patient in a modified supine position is effective and safe. It may be considered for most patients requiring percutaneous nephrolithotripsy, especially if concomitant ureteroscopy is planned.
authors.affiliation: Division of Urology, São Paulo University Medical School, São Paolo, Brazil.
authors.forename: Elias Assad Chedid
authors.initials: EA
authors.lastname: Neto
authors.forename: Anuar Ibrahim
authors.initials: AI
authors.lastname: Mitre
authors.forename: Cristiano Mendes
authors.initials: CM
authors.lastname: Gomes
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Arap
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000453:epidemiology / Q000628:therapy*; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016683:Supine Position; D014514:Ureteral Calculi / Q000453:epidemiology / Q000601:surgery; D018666:Ureteroscopy