Ultrasound guided percutaneous nephrolithotomy [PCNL] in the prone position, novel technique

ABSTRACT

Because PCNL is frequently difficult and time consuming relatively high radiation doses may be absorbed by the surgeon and other members of the interventional team in addition to the patient. A novel technique ultrasound guided percutaneous nephrolithotomy in the prone position with no radiation risk on patients, doctors and medical personnel has been tried. Twenty nine patients underwent Ultrasound guided percutaneous nephrolithotomy [PCNL] in the prone position between January 2001 and January 2007, 18 males and 11 females their ages ranged between 15 and 71 years [mean age 42.9 +/- 14.2 years]. Only in 13 patients stone was single and in 3 patients it was recurrent. All patients fulfill our inclusion criteria. The whole procedure was performed under ultrasound guidance in the operating room by urologists. No imaging or exposure to radiation has occurred during all steps of the operation. We used Nephromax balloon dilator 10 cm length; deflated 10 CH; inflated 30 CR [Nephromax; Boston Scientific, Natick, MA]. Twenty six patients were stone free[86.6%]. Auxiliary procedures were needed in 3 patients only, ureteroscopy and double J in one patient to treat leakage of urine on closure of nephrostomy tube, and ESWL in two patient for small non targeted stones. one failure due to Slippage of the system outside kidney. our complications were treated conservatively which include minimal pelvic perforation in 3 patients, minimal perirenal extravasations in one patient, pain in 14 patients, fever in 3 patients and urinary tract infection in patients. Ultrasound guided percutaneous nephrolithotomy in the prone position is safe and easy to learn technique with no radiation risk on patients, doctors and medical personnel. It is advisable to replace standard PCNL especially in radiolucent stones. Nephromax balloon is an easy, one step, with minimal bleeding, rapid tract dilator and minimal complications compared with other modalities