X-ray-free percutaneous nephrolithotomy in supine position with ultrasound guidance.
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.
Basiri
Abbas
A
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
Mohammadi Sichani
Mehrdad
M
Hosseini
Seyed Reza
SR
Moradi Vadjargah
Aliakbar
A
Shakhssalim
Nasser
N
Kashi
Amir Hossein
AH
Kamranmanesh
Mohammadreza
M
Nasseh
Hamidreza
H
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*