الفهرس | Only 14 pages are availabe for public view |
Abstract Percutaneous nephrolithotomy (PCNL) is the standard treatment for patients with complex or large upper urinary tract stones. Because it allows a large surface area for renal puncture, PCNL is routinely performed in prone position, which can also provide a wide space for instrument manipulation and avoid abdominal visceral injuries as much as possible. However, it has some potential drawbacks, especially in cardiac, obese and elderly patients. It may also increase the happening of anesthesia complications (position-related circulatory and ventilator difficulties) and be difficult for intraoperative reposition. In addition, this position is also unsuitable for numerous patients with a skeletal deformity. For PCNL in supine position, not only does it overcome the drawbacks by prone PCNL, but also provide some potential advantages. For example, it can provide an opportunity for surgeons to simultaneously perform PCNL and ureteroscopic procedures, save the operation time of patient repositioning. However, disadvantages coexist, such as it limits the space for renal puncture and it may be difficult for manipulating the nephroscope. Considering the advantages and limitations of these two positions, more and more controversies presented focusing on how to choose the optimal position for PCNL. Though several researches had compared supine with prone position for PCNL, the results were still inconclusive. The aim of this work was to study the safety and efficacy of supine position in percutaneous nephrolithotomy compared to the standard prone position. This Prospective randomized study for 60 patients admitted in Menoufia University Hospital with renal stones planned for PCNL operation during the period from November 2017 till May 2019. Summary 108 Patients with renal stones more than 2 cm included in the current studied were divided into two groups as group A: included 30 patients subjected to PCNL in the prone position. group B: included 30 patients subjected to PCNL in the modified flank free supine position. Patients with uncorrectable coagulopathy and active UTI including sepsis were excluded from our study. Results of the current study could be summarized as follow: Mean age of the studied patients was 47.53± 8.30 years, most of them were males (68.3%). Mean BMI was 31.88±7.41 kg/cm2. Most of patients had stone pelvis (38.3%) followed by patients who had stone pelvis and lower calyx (26.7%). Mean stone size 4.31± 1.38 cm and mean Hounsfield unit was 947.72± 199.11. There was statistically insignificant difference between prone and Supine position regarding age, weight, height, body mass index, sex and previous surgery (p>0.05). Regarding site of stone, 36.67% of patients with prone position had pelvis and lower calyx. While, 46.67% of patients with supine position had pelvis stone. There was no statistically significant difference between prone and Supine positions regarding operative time (p>0.05). Mean fluoroscopy time was 6.9 ± 2.4 min in prone position and 7.3 ± 2.6 min in supine position, but there was no statistically significant difference between prone and supine positions (p>0.05). A shorter hospital stay in prone (45.60±14.23 hours), than in supine position (48.60±19.84 hours) but the differences between them did not reach a statistically significant level (p>0.05). Size of stone was in range of 2.5-8 cm with mean 4.05±1.21 cm in prone group and 2.7-8.1 with 4.56±1.51cm in supine group. Whereas, Summary 109 there was no statistically significant difference between prone and Supine position regarding size of stone and Hounsfield unit (p>0.05). The auxiliary procedures reported in all patients with residual stones. in prone group, all 3 patients (100%) underwent SWL While, in supine group, 4 patients (66.7%) underwent SWL and the remaining 2 cases (33.3%) underwent 2nd look PCNL. Mean size of residual stone were increased in supine position (0.75±.31 cm) higher than in prone position (0.52±0.27cm). Also, residual stones were observed among 3 patients (10%) with prone position than 6 (20%) patients with supine position, with statistically insignificant differences between them. There was no statistically significant difference between prone and Supine position regarding DROP of hemoglobin, need of blood transfusion, stone free rate and hospital stay (p>0.05). Fever occurred in 3.3% of cases in each group and urine leakage in patient with prone group but with no statistically significant difference (p>0.05). No blood transfusion needed in both groups. |