Mini-percutaneous nephrolithotomy in supine position (report of 56 cases)

Objective To evaluate the technique of performing mini-percutaneous nephrolithotomy ( mini-PCNL) in supine position. Methods A total number of 56 patients who underwent PCNL for renal or upper ureteral calculi were carried out by ureteroscope in supine position. The calculi were located in the left kidney of 23 cases, in the right kidney of 26 cases and in the upper ureter of 7 cases, respectively. Seventeen patients had single calculus while 26 others had multiple calculi. The mean calculus diameter was 2. 6 cm×1. 7 cm. Thirteen patients had staghorn calculi with the maximal dimension of 5. 7 cm×7. 2 cm×4. 3 cm. Severe hydronephrosis was found in 9 kidneys and mild to moderate hydronephrosis was found in 29 kidneys. The ipsilateral flank was raised with a 1000 ml saline bag as pad during the procedure. The skin was punctured and the tract was dilated under the guidance of ultrasound to set up the tract for mini-PCNL. Results The successful operation rate was 100% ,while the primary stone clearance rate was 71. 4% (40/56). Residual calculi were found in 16 cases. The additional PCNLs were performed on 9 cases,and the residual calculi were completely removed. Three cases were treated by ESWL in patients who were not willing to accept additional PCNL. The total stone clearance rate was 87. 5% (49/56). Only one case required blood transfusion during the procedure. There was no severe complication during and post-operation. Conclusions The supine position is the most comfortable position for patients accepting PCNL. The stone fragments are much easier to wash out than other positions as well. This position is convenient for anesthetist to observe the patient and to converse to general anesthesia if needed.