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Modified complete supine percutaneous nephrolithotomy: solving some problems.

Fabio C Vicentini1, Fabio C M Torricelli, Eduardo Mazzucchi

  • 1Section of Endourology, Division of Urology, Hospital das ClĂ­nicas, University of Sao Paulo Medical School, Sao Paulo, Brazil. fabio_torri@yahoo.com.br

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|February 5, 2013
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Summary
This summary is machine-generated.

This study introduces a modified supine percutaneous nephrolithotomy (PCNL) technique for large kidney stones. The modified approach demonstrates a high success rate and low complication rate, making it a safe and effective treatment option.

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Area of Science:

  • Urology
  • Minimally Invasive Surgery
  • Nephrolithiasis Treatment

Background:

  • Percutaneous nephrolithotomy (PCNL) is the standard treatment for renal stones exceeding 2 cm.
  • Traditional PCNL requires a prone position, which can be challenging for some patients.

Purpose of the Study:

  • To describe a modified technique for PCNL performed in a complete supine position (csPCNL).
  • To evaluate the safety and efficacy of this modified csPCNL technique.

Main Methods:

  • Prospective evaluation of 117 patients (120 renal units) undergoing csPCNL for large stones.
  • Patients were positioned supine, with flank extension, and remained in this position throughout the procedure.
  • Stone classification used the Guy score; success was determined by CT findings post-procedure.

Main Results:

  • High success rates: 72.5% immediate and 90.4% final.
  • Low complication rate: 16.8% overall, with 4.1% Clavien III or IV.
  • No colon injuries or deaths reported; median hospital stay was 48 hours.

Conclusions:

  • Modified csPCNL is a safe and effective procedure for large renal stones.
  • The technique offers excellent outcomes with a low incidence of major complications.
  • Provides adequate access for renal puncture and surgical instrumentation.