title: Flank free modified supine position: A new modification for supine percutaneous nephrolithotomy.
abstract: OBJECTIVE
  Percutaneous nephrolithotomy (PCNL) is the standard management for large and/or complex urolithiasis, but the standard patient position for PCNL is undecided. With the patient prone PCNL has several drawbacks, while when supine, as described previously, PCNL has mechanical limitations. We describe a modification that aims to overcome these limitations and provide easy access comparable to that in the prone position.
  
  
  METHODS
  This prospective study was carried out at the Urology Department, Zagazig University, Egypt, from October 2008 to March 2011, and included 78 patients (48 men and 30 women). First the patient was placed supine and then in the 'flank-free modified' supine position. The distance between the last rib and the iliac crest in the posterior axillary line was measured in both positions.
  
  
  RESULTS
  The mean age of the patients was 40.8 years, the mean (SD) stone diameter was 3.4 (0.7) cm, the number of right/left stones was 34/44, and mean body mass index was 28.8 kg/m(2). The mean (SD) increase in the distance between the last rib and the iliac crest in the posterior axillary line in the flank free modified supine position vs. the previous supine position was 12 (0.8) mm.
  
  
  CONCLUSIONS
  The flank-free modified supine position increases the distance between the last rib and the iliac crest, and, together with the absence of a cushion under the flank, provides ample space for puncture, dilatation, multiple tracts and manoeuvrability of the system with the nephroscope.
authors.affiliation: Urology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: Esam A E
authors.initials: EA
authors.lastname: Desoky
authors.affiliation: Urology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: Mohammed N
authors.initials: MN
authors.lastname: Allam
authors.affiliation: Urology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: Mostafa K
authors.initials: MK
authors.lastname: Ammar
authors.affiliation: Urology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Abdelwahab
authors.affiliation: Urology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: Diab A
authors.initials: DA
authors.lastname: Elsaid
authors.affiliation: Urology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: Amr M
authors.initials: AM
authors.lastname: Fawzi
authors.affiliation: Urology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Alayman
authors.affiliation: Urology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: Ashraf M S
authors.initials: AM
authors.lastname: Shahin
authors.affiliation: Urology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: Hussein M
authors.initials: HM
authors.lastname: Kamel
keywords: BMI, body mass index; FFMSP, flank-free modified supine position; Flank free; KUB, abdominal plain film; PCNL, percutaneous nephrolithotomy; Percutaneous nephrolithotomy; Position; Urolithiasis