La NLPC en décubitus dorsal modifié : notre expérience

摘要

Purpose: Percutaneous nephrolithotomy (PCNL) is conventionally performed with the patient in the prone position. In this study, we assess the safety and efficacy of PCNL in the supine position. Methods: Between November 2004 and January 2010, we performed 159 percutaneous nephrolithotomies. The patient is placed in a supine modified position with an air bag underneath the operating flank. If necessary, a modified lithotomy position allowing the simultaneous antegrade and retrograde endourological access was used. The access has been realized with progressive Alken dilators or with the one-shot technique. Operative times, mean stay in hospital, complications and success rates were analyzed. Results: The mean age was 47 ± 13.1 years (range: 22–70). Twenty-one patients had previous kidney surgery. Twenty-one had solitary kidneys and 3 patients had congenital renal abnormalities. The mean stone size was 3.4 ± 1.9 cm (range: 1.3–5.4). Twenty patients (29.5%) had complete staghorn stones. Ten patients (11.4%) also had ureteral stones and underwent concomitant ureteroscopy. The mean operative time was 60 ± 29 min, including patient positioning. In 2 patients it was necessary to suspend the procedure due to of bleeding. Postoperative complications included prolonged fever in 3 patients, nephrocutaneous fistula requiring double pigtail stent placement. Arterial embolization was never required. The colon was never damaged and we had no cases of hydrothorax or kidney loss. A second early treatment using the same percutaneous access during the same hospital stay was needed in 8 patients. The stone-free rate was 91.8%. Conclusions: Percutaneous nephrolithotripsy with the patient in a modified supine position is effective and safe. It offers obvious advantages from the point of view of the patient’s comfort and use of anesthetic. There is no risk of vitiated positions or traumatisms due to the change of bed-position and no thoracic compression occurs, which makes the procedure safe in patients with associated cardiorespiratory pathologies or obese patients. Also, the risk of colon perforation is reduced, which allowed for allows access to the entire urinary collecting system.