title: Percutaneous nephrolithotomy in the supine position: Safety and outcomes in a single-centre experience.
abstract: OBJECTIVE
  To assess the feasibility of performing percutaneous nephrolithotomy (PCNL) with the patient supine. Although PCNL with the patient prone is the standard technique for treating large (>2 cm) renal stones including staghorn stones, we evaluated the safety and efficacy of supine PCNL for managing large renal stones, with special attention to evaluating the complications.
  
  
  METHODS
  In a prospective study between January 2010 and December 2011, 54 patients with large and staghorn renal stones underwent cystoscopy with a ureteric catheter inserted, followed by puncture of the collecting system while they were supine. Tract dilatation to 30 F was followed by nephroscopy, stone disintegration using pneumatic lithotripsy, and retrieval using a stone forceps. All patients had a nephrostomy tube placed at the end of the procedure. The results were compared with those from recent large series of supine PCNL.
  
  
  RESULTS
  The median (range) operative duration was 130 (90-210) min, and the mean (SD) volume of irrigant was 22.2 (3.7) L. One puncture was used to enter the collecting system in 51 renal units (94%), while three units (6%) with a staghorn stone needed two punctures. The stone clearance rate was 91%, and five patients had an auxiliary procedure. There were complications in 15 patients (28%). All patients were stone-free at a 3-month follow-up.
  
  
  CONCLUSIONS
  Supine PCNL is technically feasible; it has several advantages to patients, urologists and anaesthesiologists. It gives stone-free rates and a low incidence of organ injury comparable to those in standard prone PCNL.
authors.affiliation: Urology Department, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Hani H
authors.initials: HH
authors.lastname: Nour
authors.affiliation: Urology Department, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Kamal
authors.affiliation: Urology Department, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Samir E
authors.initials: SE
authors.lastname: Ghobashi
authors.affiliation: Urology Department, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Ahmed S
authors.initials: AS
authors.lastname: Zayed
authors.affiliation: Urology Department, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Mamdouh M
authors.initials: MM
authors.lastname: Rushdy
authors.affiliation: Urology Department, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Ahmed G
authors.initials: AG
authors.lastname: El-Baz
authors.affiliation: Urology Department, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Ahmed I
authors.initials: AI
authors.lastname: Kamel
authors.affiliation: Urology Department, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Tarek
authors.initials: T
authors.lastname: El-Leithy
keywords: BMI, body mass index; Outcome; PCN, percutaneous nephrostomy; PCNL, percutaneous nephrolithotomy; Percutaneous nephrolithotomy; Renal stones; Supine