A Prospective Study of Supine Percutaneous Nephrolithotomy with a Modified Technique:
A Safe and Desirable Tool in the Armamentarium of Urologists
Dr. Vivek Kumar Vijjan,
Associate Professor, Department of Urology, SGRRIM and HS and SMI Hospital,
Patel Nagar, Dehradun-248001, Uttarakhand, India.
Introduction: Supine Percutaneous Nephrolithotomy (PCNL) has failed to gain popularity despite the various advantages, primarily due to a lack of standardised technique. A simple and replicable technique is needed to increase its popularity amongst urologists.
Aim: To simplify and standardise the puncture technique of supine PCNL and compare it with the Clinical Research Office of the Endourological Society (CROES) PCNL global study.
Materials and Methods: A prospective interventional study was conducted in a tertiary care hospital in Dehradun, Uttarakhand, India, between June-December 2020. A total of 82 consecutive patients underwent the procedure with a modified technique of initial puncture using bony landmarks. The results of present study were compared with the outcomes of the patients who underwent supine PCNL in the CROES PCNL global study which is the largest prospective database regarding the supine and prone positions of PCNL till date. Statistical analysis of various demographic variables, patient characteristics and results was done using Statistical Package for the Social Sciences (SPSS) version 24.0 software.
Results: The mean age of patients was 47.52±13.044 years and mean stone burden of 266.146±172.430 mm2. The mean operative time was 85.59±12.733 minutes. Lower calyceal puncture was done in 97.56% of patients. Stone clearance was achieved by a single puncture in 73 (89.0%) patients while 9 (11.0%) patients required two punctures. Sixteen patients (19.51%) had postnephrostomy drain removal leak which settled within 24 hours. Only in one patient the leak continued beyond 24 hours but was managed conservatively. On comparison, it was observed that mean stone burden was lesser (p-value=0.0001) and the stone free rate was comparatively higher in present study (p-value=0.024).
Conclusion: Supine PCNL is an effective and safe procedure in a subset of patients with predominant lower calyceal stone bulk.