Calcutta position: A new modified supine decubitus for supine PCNL

Area of Science:

• Urology
• Nephrology
• Surgical Innovation

Background:

• Percutaneous nephrolithotripsy (PCNL) is the gold standard for large renal stones (>2 cm).
• Supine PCNL is as effective as prone PCNL, but the optimal patient position remains debated.
• Novel positioning strategies are explored to enhance PCNL efficacy and safety.

Purpose of the Study:

• To evaluate the initial experience and outcomes of supine PCNL performed in a novel 'Calcutta position'.
• To assess the safety and effectiveness of this technique in a diverse patient cohort.
• To compare stone-free rates and complication profiles with existing PCNL methods.

Main Methods:

• A prospective study involving 60 patients undergoing supine PCNL in the 'Calcutta position'.
• Procedures were conducted between August 2021 and August 2022.
• Success defined by complete stone clearance or clinically insignificant residual fragments (<4 mm).

Main Results:

• The immediate stone-free rate was 84.2% for single, 71.4% for multiple, and 37.5% for staghorn calculi.
• At 3 months, stone-free rates improved to 92%, 85%, and 75% respectively.
• The 'Calcutta position' proved effective in complex cases including obese patients, those with kyphoscoliosis, ADPKD, and malrotated kidneys.

Conclusions:

• Supine PCNL in the 'Calcutta position' is a safe and effective treatment for nephrolithiasis.
• This position offers advantages in C-Arm and nephroscope maneuverability.
• The technique demonstrated comparable success rates in various challenging anatomical and pathological scenarios.