Clinical Analysis on Lithotomy Position with Lateral Tilt in Percutaneous Nephrolithotripsy

Objective To discuss the safety and efficacy of percutaneous nephrolithotripsy(PCNL) in a new operative position-lithotomy position with lateral tilt.Methods 75 patients with kidney calculi were treated by PCNL in lithotomy position with lateral tilt,including 40 patients of left lateral calculi and 37 patients of right lateral calculi.The maximum diameter of stone was 15 to 65 mm(mean 18.6mm) in 75 kidney calculi cases,including 67 cases with multiple stones in kidney pelvis and kidney calices and 8 cases with proplasm stones.Out of them,27 cases combined ureteral calculi with average 12.2 mm of maximum diameter of stones.The position held 45° lateral tilt by raising the ipsilateral shoulder and haunch with cushions,lying on lower limb unbended and buckled to the foot shelf of a surgery bed.Results All 75 cases performed PCNL successfully and appeared well tolerance.No one converse to open surgery with 90.4±35.6 minutes of average operative time and 130.2±12.6 ml of average intraoperative hemorrhage.Blood transfusion was not applied.7 cases were found high fever after operation and cured by anti-infective therapy.There was no complication such as kidney pelvis perforation,ureteral and visceral injury,septicemia,shock and so on.The renal fistulization tube was removed at 2 to 6 days and the double-J tube was removed 4 week after operation.70 cases out of the kidney patients were achieved stone free at stage one,and the one-stage clearance rate of stones was 93.3%.Five cases of kidney stones was found residual stones,and cleared by second PCNL in 2 cases and ESWL in 3 cases.All 27 cases combined ureteral stones were cleared after one-stage PCNL.All 75 cases were followed up for 3 months,and not found residual stones by KUB re-exam.Conclusion The lithotomy position with lateral tilt is safe and effective for PCNL with good tolerance in patients.