title: X-ray-free percutaneous nephrolithotomy in supine position with ultrasound guidance.
abstract: OBJECTIVE
  Supine percutaneous nephrolithotomy (PCNL) has numerous benefits compared to the prone position, including lower anesthesia risk, shorter operating time, and better ergonomic position for the surgeon. It is also comparable to prone position regarding vascular and bowel injuries. This study was conducted to add some more benefits by omitting X-ray in PCNL in a supine position.
  
  
  METHODS
  Nineteen consecutive adult patients underwent ultrasound-guided PCNL in supine position. All patients were placed under ultrasound guidance in supine position. The tract was dilated over a guidewire in a single shot technique under ultrasound guidance from anterior abdominal wall. Once the procedure ended, residual stone was controlled using ultrasound with anterior abdominal wall window. Residual stones less than 5 mm were considered insignificant. No X-ray was used in any setting of the procedure.
  
  
  RESULTS
  The pelvicaliceal system could be successfully approached in all patients. The posterior calices were the most common sites of entry. Mean (range) of operation time was 111 (70-180) min. Mean + or - SD hemoglobin before PCNL was 14.0 + or - 2.2 mg/dl, and after the procedure it was 12.3 + or - 1.6 mg/dl. Only one patient required blood transfusion. Mean + or - SD creatinine before PCNL was 1.03 + or - 0.24 mg/dl, and after the procedure it was 1.11 + or - 0.22 mg/dl. None of the patients suffered visceral injury. The total stone-free rate was 84%.
  
  
  CONCLUSIONS
  Even in our first report with limited experience, it seems that the efficacy of PCNL with ultrasonography in supine position is comparable to PCNL in prone position with fluoroscopy with no more complications.
authors.affiliation: Department of Urology, Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University, M.C. (SBMU), No.101, Boostan 9th St., Pasdaran Ave., P.O. Box 1666677951, Tehran, Iran. basiri@unrc.ir
authors.forename: Abbas
authors.initials: A
authors.lastname: Basiri
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Mohammadi Sichani
authors.forename: Seyed Reza
authors.initials: SR
authors.lastname: Hosseini
authors.forename: Aliakbar
authors.initials: A
authors.lastname: Moradi Vadjargah
authors.forename: Nasser
authors.initials: N
authors.lastname: Shakhssalim
authors.forename: Amir Hossein
authors.initials: AH
authors.lastname: Kashi
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Kamranmanesh
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Nasseh
mesh_terms: D034861:Abdominal Wall / Q000000981:diagnostic imaging; D000328:Adult; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation* / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D016683:Supine Position; D018084:Ultrasonography, Interventional / Q000379:methods*; D014545:Urinary Calculi / Q000000981:diagnostic imaging* / Q000601:surgery*