Supine position further minimises invasiveness of tubeless PCNL

Poster session, 25th Anniversary EAU Congress, Barcelona

Monday, 24 May 2010- Several reports have already demonstrated safety and efficacy of tubeless percutaneous nephrolithotomy  PCNL (only a double-J stent without nephrostomy tube) in strongly selected patients.

G. Giusti and colleagues conducted a retrospective study to find out whether or not supine position further minimises invasiveness of tubeless PCNL. They presented their findings at the 25th Anniversary EAU Congress held in Barcelona, Spain,

After the introduction at their “Stone Center ” back in June 2002, Giusti and colleagues  performed 140 tubeless PCNLs for renal calculi. Among them, 89 were after prone PCNL while 51 after supine PCNL.

Selection criteria for tubeless procedure do not differ between the 2 positions. Prone tubeless PCNL is performed in traditional way placing antegrade the JJ stent that is removed cystoscopically. Supine tubeless PCNL is carried out according to Galdakao-modified supine Valdivia position so that a permanent retrograde access to collecting system is guaranteed.

In this way, endoscopic combined intrarenal surgery (ECIRS according to Scoffone & Scarpa) can be performed when needed and, furthermore, at the end of the procedure is possible to place retrograde the JJ stent leaving the tether suture for its self-removal.

Postoperative pain was assessed using the validated pain questionnaire visual analogue scale (VAS) administered at day 1 postop and after stent removal.

Table 1: patients’ characteristics

 

 

 

supine

prone

Number of patients

51

89

Mean age (years)

47.5 (22-77)

50.3 (29-71)

BMI

24.6

25.1

Stone burden (cm2)

4.9 (2.1-17.0) cm2

5.4 (2.2-23.2) cm2

Results are reported in table 2, below:

 

 

Supine

Prone

P

Anaesthesia time (min)

69

109

<0.001

Mean blood loss (?Hb) g/dL
# of transfused patients

-2,4
2 (3,9%)

-1,9
3 (3,37%)

0.10
0.2

Colonic injuries

0

0

 

Hospital stay (days)

2,2 (1-9)

2,5 (2-12)

0.1

VAS score postop. day 1

3.4

3.6

0.1

VAS score after stent removal

2,6

4,4

0.02

Stone free rate (%)

96,1%

97,5%

0.16

"Results do not differ significantly between these 2 series in terms of blood loss, complications’ and stone free rate. On the counterpart, supine position further reduces invasiveness of tubeless PCNL shortening anaesthesia time and discomfort related to stent removal that after tubeless PCNL in supine position is carried out by the patient himself at home instead of by means of flexible cystoscopy on ambulatory basis," the researchers concluded.

Source: G. Giusti, et al., "Supine position further minimizes invasiveness of Tubeless Percutaneous Nephrolithotomy (PCNL)," Abstract 5, Poster Session, 25th Anniversary EAU Congress, April 16 to 20, 2010, Barcelona, Spain.

 

Edited by: JV


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