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Prone vs supine percutaneous nephrolithotomy: does position affect renal pelvic pressures?

Prone vs supine percutaneous nephrolithotomy: does position affect renal pelvic pressures?

Authors :
Farkouh A
Park K
Buell MI
Mack N
De Guzman C
Clark T
Baldwin EA
Shete K
Leu R
Amasyali AS
Seibly E
Cheng KW
Song S
Okhunov Z
Baldwin DD
Source :
Urolithiasis [Urolithiasis] 2024 Apr 17; Vol. 52 (1), pp. 66. Date of Electronic Publication: 2024 Apr 17.
Publication Year :
2024

Abstract

The purpose of this study was to measure and compare renal pelvic pressure (RPP) between prone and supine percutaneous nephrolithotomy (PCNL) in a benchtop model. Six identical silicone kidney models were placed into anatomically correct prone or supine torsos constructed from patient CT scans in the corresponding positions. A 30-Fr renal access sheath was placed in either the upper, middle, or lower pole calyx for both prone and supine positions. Two 9-mm BegoStones were placed in the respective calyx and RPPs were measured at baseline, irrigating with a rigid nephroscope, and irrigating with a flexible nephroscope. Five trials were conducted for each access in both prone and supine positions. The average baseline RPP in the prone position was significantly higher than the supine position (9.1 vs 2.7 mmHg; p < 0.001). Similarly, the average RPP in prone was significantly higher than supine when using both the rigid and flexible nephroscopes. When comparing RPPs for upper, middle, and lower pole access sites, there was no significant difference in pressures in either prone or supine positions (p > 0.05 for all). Overall, when combining all pressures at baseline and with irrigation, with all access sites and types of scopes, the mean RPP was significantly higher in the prone position compared to the supine position (14.0 vs 3.2 mmHg; p < 0.001). RPPs were significantly higher in the prone position compared to the supine position in all conditions tested. These differences in RPPs between prone and supine PCNL could in part explain the different clinical outcomes, including postoperative fever and stone-free rates.<br /> (© 2024. The Author(s).)

Details

Language :
English
ISSN :
2194-7236
Volume :
52
Issue :
1
Database :
MEDLINE
Journal :
Urolithiasis
Publication Type :
Academic Journal
Accession number :
38630256
Full Text :
https://doi.org/10.1007/s00240-024-01555-6