title: Percutaneous nephrostomy, nephrolithotomy and combined ureteroscopic lithotripsy using the supine approach.
abstract: OBJECTIVE
  (1) To evaluate the safety and efficacy of supine percutaneous nephrostomy, nephrolithotomy, and combined percutaneous nephrolithotomy and ureteroscopic lithotripsy. (2) To describe the skill-acquiring process in supine procedures and share our initial experience.
  
  
  METHODS
  Three-staged case series with prospective data collection.
  
  
  METHODS
  Two public hospitals in Hong Kong.
  
  
  METHODS
  Stage 1: Forty patients indicated for percutaneous renal access were recruited for supine percutaneous nephrostomy with prospective data collection. Stage 2: A prospective comparative study of percutaneous nephrolithotomy involving 60 patients allocated non-randomly to a supine (n=25) or prone (n=35) approach was conducted. Stage 3: Data of 11 patients who underwent simultaneous supine percutaneous nephrolithotomy and ureteroscopic lithotripsy were prospectively captured.
  
  
  RESULTS
  Stage 1: The procedural success rate was 100%. The mean operating time in unilateral procedures was 44 minutes; one patient had perinephric haematoma as a complication. Stage 2: Overall stone-free rates for prone and supine procedures were 46% and 68%, respectively (P=0.087), and mean operating times were 122 and 123 minutes, respectively (P=0.905). Stage 3: Of the 11 patients, six were rendered stone-free after the first combined procedure, and one experienced transient postoperative fever. There was no major complication.
  
  
  CONCLUSIONS
  Percutaneous nephrolithotomy was feasible via both prone and supine approaches. With the exception of staghorn stones, the supine percutaneous approach was an equally safe and effective option for patients with specific conditions favouring such an approach. The ability to incorporate simultaneous ureteroscopic lithotripsy was an additional benefit of adopting the supine approach.
authors.affiliation: Department of Surgery, Queen Mary Hospital, Pokfulam, Hong Kong. kwm.raymond@yahoo.com
authors.forename: Raymond W M
authors.initials: RW
authors.lastname: Kan
authors.forename: Kenneth K F
authors.initials: KK
authors.lastname: Fu
authors.forename: Bill T H
authors.initials: BT
authors.lastname: Wong
authors.forename: K L
authors.initials: KL
authors.lastname: Ho
authors.forename: M K
authors.initials: MK
authors.lastname: Yiu
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong; D006801:Humans; D007669:Kidney Calculi / Q000175:diagnosis / Q000601:surgery*; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D056888:Patient Positioning; D061214:Patient Safety; D016684:Prone Position; D012189:Retrospective Studies; D018570:Risk Assessment; D016683:Supine Position; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000379:methods*
keywords: Kidney calculi; Nephrostomy, percutaneous; Patient positioning; Supine position