Tubeless PCNL in Supine Position

abstract

Abstract Objective: Percutaneous nephrolithotomy has been historically performed in prone position with inherent drawbacks. Supine PCNL has numerous benefits in terms of safety, efficacy, versatility and is comparable in respect of vascular and bowel injury. This study is intended to prove that PCN...

L in supine position is an alternative way of doing PCNL along with comprehensive technique. Material and Method: A total of 184 patients with 191 renal units underwent tubeless supine PCNL from 2005 to May 2007, mean age being 32 years, mean weight 62 kg. After insertion of retrograde 5F ureteral catheter, patients are placed in supine position with small towel roll under the ipsilateral flank raising it by 20º. Calyceal entry is achieved with 18G spinal needle and tract is dilated up to 28F with Alkans dilators over 0.032 inch guide wire under general anaesthesia using fluoroscope only. Results: The primary stone clearance was achieved in 84% patients. 94% patients had single and 6% had double tract. 72% patients had lower, 25% had middle and 3% had upper calyceal puncture. Mean single stone size was 3.5cm and mean multiple stone burden was 12cm.No vascular, splanchnic injury or bowel transgression was observed. Tubeless PCNL was secured in 87% patients. 4% patients required transfusion, 1 patient each had perinephric collection, plural effusion. Conclusion: The tubeless PCNL in supine position is an independent method of treating renal stones without complimenting PCNL in prone position. It adds ease and comfort to the patient, anaesthetist and to the surgeon.

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