title: Unplanned flexible ureteroscopy during percutaneous nephrolithotomy in the prone position.
abstract: BACKGROUND
  Over time, the prone position has been shown to be effective and safe for performing percutaneous nephrolithotomy. One of its disadvantages, however, is the inability to simultaneously perform an ureteroscopy after positioning the patient, which is feasible in the supine position. Our objective is to demonstrate the feasibility of implementing flexible ureteroscopy with the patient in the prone position.
  
  
  METHODS
  We present a case of percutaneous nephrolithotomy of partial staghorn calculi in the prone position during which access to the middle calyx was not possible. It was therefore necessary to conduct flexible ureteroscopy. The 64-year-old female patient had consulted for lumbar pain of 6 months of evolution.
  
  
  RESULTS
  We performed percutaneous nephrolithotomy in the prone position. After extracting calculi from the inner calyx and renal pelvis, access to the fragments located in the middle calyx could not be achieved. Rather than performing a new puncture, we decided to enter in a retrograde manner with a flexible ureteroscope, succeeding in extracting the residual calculi, leaving the patient completely free of calculi.
  
  
  CONCLUSIONS
  In our case, the implementation of retrograde flexible ureteroscopy was feasible without changing the patient's original position.
authors.affiliation: Sección Litiasis y Endourología, Departamento Urología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina.
authors.forename: N
authors.initials: N
authors.lastname: Bernardo
authors.affiliation: Sección Litiasis y Endourología, Departamento Urología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina. Electronic address: maximilianolopezsilva@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Lopez-Silva
authors.affiliation: Sección Litiasis y Endourología, Departamento Urología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina.
authors.forename: H
authors.initials: H
authors.lastname: Sanguinetti
authors.affiliation: Sección Litiasis y Endourología, Departamento Urología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina.
authors.forename: C
authors.initials: C
authors.lastname: Cabral
authors.affiliation: Sección Litiasis y Endourología, Departamento Urología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina.
authors.forename: J
authors.initials: J
authors.lastname: Aguilar
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation* / Q000379:methods*; D056888:Patient Positioning; D016684:Prone Position; D020709:Ureteroscopes; D018666:Ureteroscopy
keywords: Flexible ureteroscopy; Nefrolitotomía percutánea; Percutaneous nephrolithotomy; Prone; Prono; Ureteroscopia flexible