title: Modified supine percutaneous nephrolithotomy for large kidney and ureteral stones: technique and results.
abstract: BACKGROUND
  Percutaneous nephrolithotomy (PCNL) is the standard treatment for kidney stones >2cm. Recently, a novel approach in the modified supine lithotomy position has been developed.
  
  
  OBJECTIVE
  To demonstrate with a video our technique of supine PCNL (sPCNL) and present our experience.
  
  
  METHODS
  From September 2009 to August 2010, 47 consecutive patients were prospectively evaluated. There were 31 single, 9 multiple, and 7 staghorn stones. The mean body mass index was 26.1±5 (range: 17.3-45.7), the mean stone size was 29.6±15.3mm (range: 10-75), and patients' American Society of Anesthesiologists scores were 1, 2, and 3 in 31, 11, and 5 cases, respectively.
  
  
  METHODS
  Patients were positioned in Galdakao-modified supine Valdivia position. The details of the technique are shown in the film.
  
  
  METHODS
  Success was defined as patients free of stones or with residual stone fragments <4mm.
  
  
  CONCLUSIONS
  Average operative room occupation time was 123.5±51.2min (range: 50-245). In the single, multiple, and staghorn stone groups, the immediate success rate after sPCNL was 90%, 78%, and 43%, respectively. Complications included one fever, two incidents of pyelonephritis, one renal colic, two urinary fistulae, one postoperative hemorrhage, and one incident of acute urinary retention. Mean hospital stay was 3.4±1.9 d (range: 2-12). Nine patients (19%) had a secondary procedure (extracorporeal shock wave lithotripsy or flexible ureterorenoscopy). At 3 mo, the success rate was 97%, 100%, and 100% in the single, multiple, and staghorn stone groups, respectively. However, the limitation of this study is its design, which is descriptive rather than comparative.
  
  
  CONCLUSIONS
  sPCNL is a safe and reproducible method. It offers the advantage of simultaneous retrograde and antegrade endoscopic combined intrarenal surgery, and we believe it is a further advancement in stone management. In addition, it is easier from the anesthetist point of view than the traditional prone approach. In our hands, it meant a simplification of the operative technique, resulting in a more time-efficient procedure.
authors.affiliation: Service d'Urologie CHU Henri Mondor, Créteil, France.
authors.forename: András
authors.initials: A
authors.lastname: Hoznek
authors.forename: Julie
authors.initials: J
authors.lastname: Rode
authors.forename: Idir
authors.initials: I
authors.lastname: Ouzaid
authors.forename: Bernard
authors.initials: B
authors.lastname: Faraj
authors.forename: Michael
authors.initials: M
authors.lastname: Kimuli
authors.forename: Alexandre
authors.initials: A
authors.lastname: de la Taille
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
authors.forename: Clément-Claude
authors.initials: CC
authors.lastname: Abbou
mesh_terms: D005260:Female; D005602:France; D006801:Humans; D007669:Kidney Calculi / Q000175:diagnosis / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000379:methods*; D056888:Patient Positioning; D011446:Prospective Studies; D016683:Supine Position; D013997:Time Factors; D016896:Treatment Outcome; D053039:Ureterolithiasis / Q000175:diagnosis / Q000628:therapy*