Percutaneous Nephrolithotomy with the Patient in Half Jackknife Position - Abstract
Background and Purpose: Percutaneous nephrolithotomy (PNL) is the stander therapy for large upper urinary tract stones. The optimal patient position remains controversial. The purpose of this prospective study is to investigate PNL safety, success, and complications using half jackknife position.
Patients and methods: Between October 2015 to January 2017, 55 patients underwent PCNL in half jackknife position. Inclusion criteria were single or multiple renal stones, stone diameter ? 2cm, body mass index (BMI) above 25 kg/m2, and no contraindications to performing the operation in the prone position. Exclusion criteria were active urinary tract infection, pregnancy, bleeding and coexisting renal anomalies. Perioperative data, patient’s demographic, stone, operative, postoperative and follow-up data were recorded. Successful treatment was defined as stone free or stones (?4mm) visible on NCCT scan at 3months.
Results: A total of 55 patients, with a mean age of 37.3 (range 24–70 year) years and mean body mass index of 31kg/m2, underwent PCNL in the half jackknife position, male-to-female ratio13:42. Mean stone size was 3.6 cm; a single puncture was needed in 51 (92.7%) only 4 patients needed 2 punctures (7.3%). A tubeless procedure was done in 48 patients (87.27%). Stone-free rate was 92.7%. Hospital stay was 2.3 days. An overall complication rate was 7 patients (12.7%).
Conclusion: PNL in half jackknife position is safe and effective in a short obese patient; it is more comfortable for the surgeon without challenges added in the puncture and no significant difference in hemodynamic and ventilator changes between prone and half jackknife positions.