Pcnl in supine position

Vavic B, Jeremic A, Milosevic A. and Radulovic S.

Clinical hospital “Zvezdara”, Department of Urology

INTRODUCTION: since it’s invention, PCNL was performed in prone position. Appereance of anesthesiological problems and the need of performing ureterorenoscopic procedures in the same time necessitated the introduction of PCNL in supine position.

PATIENTS AND METHOD: 27 Fr nephroscope was used . Wtih EMS Swiss Lithoclast lithotripter and Lithovac master suction system, we performed stone disintegration. Punction is performed under ultrasonographic control. For dilatation of nephrostomy channel we used Cook dilatation the “Ultraxx” system with balloon insufflated till 18mmH2O and 30 Fr amplatz sheath. In this video, we are going to demonstrate two patients. First patient was 50 years old man with multiple stones of 5-8mm in diameter located in lower pole of kidney and solitary stone of 10mm in diameter in mid calyx. Firstly, larger stone from mid calyx was extracted. Fragments were extracted by the grasper. Second case was 30 years old woman with recidivate nephrolithiasis consisted of large stone of 40 x 20mm in diameter situated in lower pole of kidney and encrustrated “double J” stent. After lower pole stone disintegration, encrustrated “double J” stent removal was performed. Nephrostomic catheter was left in both patients. Postoperative plane radiograms showed no residual stones.

RESULTS: interventions lasted approximately 50 minutes. We had no complications, except of minor bleeding that was resolved with short time occlusion of nephrostomic catheter.

CONCLUSION: comparing with PCNL in prone position, PCNL in supine position is more safer method with possibility of retrograde approach to kidney in the same time