title: Percutaneous nephrolithotomy in semisupine position: a modified approach for renal calculus.
abstract: Conventional percutaneous nephrolithotomy (PCNL) is usually performed in a prone position, which compresses the thorax and results in difficulty in rescue during operation. When PCNL is performed in a supine position, the flank renal puncture area is limited, so it is difficult to treat disseminated and complex renal calculi. Herein, we introduce a modified semisupine position for performing PCNL, which has numerous benefits as well as safe and effective. Between May 2002 and May 2009, a total of 452 patients with renal calculi were treated with semisupine PCNL. The patient was placed in 45° semisupine position during the procedure, with the affected flank arched as much as possible. In this series, no one converted to open surgery. The average operating time was (115.2 ± 44.5) min. Single tract PCNL was performed for 80.97% of the cases, two tracts 13.94%, three tracts 4.65%, and four tracts 0.44%. The upper, middle, and lower calix tracts accounted for 12.1, 63.0, and 24.9%, of procedures, respectively. Stone-free rate was 85.7% overall, 92.2% for single calculus (83/90), and 72.9% for staghorn calculi (78/107). Major postoperative complications occurred in 3.3% of the cases. This study demonstrated PCNL in a semisupine position is an effective alternative for treating renal calculi, which combines the advantages of PCNL in a prone position, and PCNL in a supine position. The semisupine position allows easier irrigation of stone fragments, is more comfortable for the patient, and facilitates monitoring of anesthesia.
authors.affiliation: Department of Urology, The Memorial Hospital of Sun Yat-Sen University, Guangzhou, 510120, China.
authors.forename: Ke-Wei
authors.initials: KW
authors.lastname: Xu
authors.forename: Jian
authors.initials: J
authors.lastname: Huang
authors.forename: Zheng-Hui
authors.initials: ZH
authors.lastname: Guo
authors.forename: Tian-Xin
authors.initials: TX
authors.lastname: Lin
authors.forename: Cai-Xai
authors.initials: CX
authors.lastname: Zhang
authors.forename: Hao
authors.initials: H
authors.lastname: Liu
authors.forename: Jian
authors.initials: J
authors.lastname: Chun
authors.forename: You-Sheng
authors.initials: YS
authors.lastname: Yao
authors.forename: Jin-Li
authors.initials: JL
authors.lastname: Han
authors.forename: Hai
authors.initials: H
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D015994:Incidence; D007669:Kidney Calculi / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011187:Posture; D012189:Retrospective Studies; D016683:Supine Position; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult