title: Modified complete supine percutaneous nephrolithotomy: solving some problems.
abstract: OBJECTIVE
  Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for patients with renal stones larger than 2 cm. In this article, we aim to describe our modified technique with the patient in a complete supine position for PCNL (csPCNL).
  
  
  METHODS
  A total of 117 patients (120 renal units) who underwent csPCNL for large stones from November 2008 to November 2011 were prospectively evaluated. One surgeon worked in two different institutions and performed all operations. All patients underwent CT preoperatively, and the stones were classified according to the Guy score. Patients were placed in the supine decubitus position with the posterior axillary line located just outside the border of the surgical table, and the flank was extended to increase the space between the last rib and the iliac crest. The csPCNL was performed without a rolled towel under the flank, and the patients remained in the same position during the entire procedure. Success was evaluated based on CT findings at the end of follow-up.
  
  
  RESULTS
  There was no failure of access. The median operative time was 100 (20-240) minutes. The immediate and final success rates were 72.5% and 90.4%, respectively. The complication rate was 16.8% (12.7% of Clavien I or II and 4.1% of Clavien III or IV). There were no colon injuries or deaths. The median hospital stay was 48 (24-840) hours.
  
  
  CONCLUSIONS
  Modified csPCNL is a safe and effective procedure with excellent outcomes and a low rate of major complications. It provides a good area for renal puncture and surgical instrumentation.
authors: Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil. fabio_torri@yahoo.com.br
authors: Fabio C
authors: FC
authors: Vicentini
authors: Fabio C M
authors: FC
authors: Torricelli
authors: Eduardo
authors: E
authors: Mazzucchi
authors: Marcelo
authors: M
authors: Hisano
authors: Claudio B
authors: CB
authors: Murta
authors: Alexandre
authors: A
authors: Danilovic
authors: Joaquim F A
authors: JF
authors: Claro
authors: Miguel
authors: M
authors: Srougi
mesh_terms: D000328:Adult; D004867:Equipment Design; D005260:Female; D006801:Humans; D007668:Kidney / Q000601:surgery; D007669:Kidney Calculi / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D058638:Operating Tables; D061646:Operative Time; D011446:Prospective Studies; D016683:Supine Position; D016896:Treatment Outcome