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Impact of patient position on the outcomes of percutaneous neprolithotomy for complex kidney stones
Vicentini, Fabio Carvalho; Perrella, Rodrigo; Souza, Vinicius M. G; Hisano, Marcelo; Murta, Claudio Bovolenta; Claro, Joaquim Francisco de Almeida.
  • Vicentini, Fabio Carvalho; Hospital Brigadeiro. Setor de Endourologia e Litíase. Departamento de Urologia. São Paulo. BR
  • Perrella, Rodrigo; Hospital Brigadeiro. Setor de Endourologia e Litíase. Departamento de Urologia. São Paulo. BR
  • Souza, Vinicius M. G; Hospital Brigadeiro. Setor de Endourologia e Litíase. Departamento de Urologia. São Paulo. BR
  • Hisano, Marcelo; Hospital Brigadeiro. Setor de Endourologia e Litíase. Departamento de Urologia. São Paulo. BR
  • Murta, Claudio Bovolenta; Hospital Brigadeiro. Setor de Endourologia e Litíase. Departamento de Urologia. São Paulo. BR
  • Claro, Joaquim Francisco de Almeida; Hospital Brigadeiro. Setor de Endourologia e Litíase. Departamento de Urologia. São Paulo. BR
Int. braz. j. urol ; 44(5): 965-971, Sept.-Oct. 2018. tab
Article in English | LILACS | ID: biblio-975638
ABSTRACT
ABSTRACT

Purpose:

To evaluate the impact of the patient position on the outcomes of PCNL among patients with complex renal stones. Material and

Methods:

From July 2011 to July 2014, we collected prospective data of consecutive patients who underwent PCNL. We included all patients with complex stones (Guy's Stone Score 3 or 4 (GSS) based on a CT scan) and divided them based on the position used during PCNL (prone or supine). The variables analyzed were gender, age, body mass index, ASA score, stone diameter, GSS, number of punctures, calyx puncture site, intercostal access and patient positioning. Complications were graded according to the modified-Clavien Classification. Success was considered if fragments ≤ 4mm were observed on the first postoperative day CT scan.

Results:

We analyzed 240 (46.4%) of 517 PCNL performed during the study period that were classified as GGS 3-4. Regarding patient positions, 21.2% were prone and 79.8% were supine. Both groups were comparable, although intercostal access was more common in prone cases (25.5% vs 10.5%; p=0.01). The success rates, complications, blood transfusions and surgical times were similar for both groups; however, there were significantly more visceral injuries (10.3% vs 2.6%; p=0.046) and sepsis (7.8% vs 2.1%; p=0.042) in prone cases.

Conclusion:

Supine or prone position were equally suitable for PCNL with complex stones and did not impact the success rates. However, supine position was associated with fewer sepsis cases and visceral injuries.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Nephrostomy, Percutaneous / Kidney Calculi / Supine Position / Prone Position / Patient Positioning Type of study: Observational study / Risk factors Limits: Female / Humans / Male Language: English Journal: Int. braz. j. urol Journal subject: Urology Year: 2018 Type: Article Affiliation country: Brazil Institution/Affiliation country: Hospital Brigadeiro/BR

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Full text: Available Index: LILACS (Americas) Main subject: Nephrostomy, Percutaneous / Kidney Calculi / Supine Position / Prone Position / Patient Positioning Type of study: Observational study / Risk factors Limits: Female / Humans / Male Language: English Journal: Int. braz. j. urol Journal subject: Urology Year: 2018 Type: Article Affiliation country: Brazil Institution/Affiliation country: Hospital Brigadeiro/BR