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Prone Percutaneous Nephrolithotomy: Does Bolster Orientation Matter?

Daniel Sagalovich1, Cecilia Besa2, Timothy Y Tran1

  • 1Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.

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|July 23, 2017
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Summary

Horizontal bolster orientation during prone kidney surgery significantly lowers the kidney, potentially reducing the need for supracostal access and associated pleural injury risks.

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Area of Science:

  • Urology
  • Nephrology
  • Surgical Imaging

Background:

  • Percutaneous nephrolithotomy (PCNL) is a key procedure for kidney stone removal.
  • Patient positioning, including bolster use, is critical for surgical access and safety.
  • Supracostal access in PCNL increases the risk of pleural injury.

Purpose of the Study:

  • To evaluate the impact of horizontal versus vertical bolster orientation on kidney position during prone PCNL.
  • To determine if bolster orientation influences the risk of pleural injury by altering kidney-to-pleura distance.

Main Methods:

  • Prospective trial involving 10 subjects (20 renal units) using MRI in prone position.
  • Comparison of kidney position with vertically oriented bolsters versus horizontally oriented bolsters.
  • Measurement of kidney-to-diaphragm, kidney-to-vertebra, and kidney-to-rib distances; assessment of nephrostomy tract characteristics.

Main Results:

  • Horizontal bolsters significantly increased right and left kidney-to-diaphragm distance (3.44 cm and 1.86 cm, respectively).
  • Significant increases in right kidney-to-rib (2.4 cm) and right kidney-to-vertebra (2.16 cm) distances were observed with horizontal bolsters.
  • No significant differences were found in access angle, tract length, or colon position.

Conclusions:

  • Horizontal bolster orientation promotes caudal kidney displacement during prone PCNL.
  • This displacement may reduce the necessity for supracostal access, thereby enhancing procedural safety.
  • Horizontal orientation may also improve the safety of supracostal access when it is required.