Complete supine PCNL: ultrasound vs. fluoroscopic guided: a randomized clinical trial.

INTRODUCTION AND HYPOTHESIS: To compare complications and outcomes of complete supine percutaneous nephrolithotomy (csPCNL) with ultrasound guided and fluoroscopically guided procedure. MATERIALS AND METHODS: In this randomized clinical trial study from January 2009 to September 2010, 26 of 51 patients with renal stones underwent csPCNL with ultrasonographic guidance in all steps of the procedure (group A), and the other 25 patients underwent standard fluoroscopically guided csPCNL (group B). All of the patients underwent PCNL in the complete supine position. Statistical analysis was performed with SPSS16 software. RESULTS: Mean BMI was 28.14 in group A and 26.31 in group B (p=0.30). The mean stone burden was 26.48 and 30.44 in groups A and B, respectively (p=0.20). The stone free rate was 88.5% in group A and 75.5% in group B, that was no significant (p=0.16). Overall 2 patients (7.7%) in group A and 6 patients (24%) in group B had complications (p=0.11). Mean operative time in group A was 88.46 minutes, and in group B it was 79.58 minutes (p=0.39). Mean hospital stay was 69.70 and 61.79 hours in group A and B, respectively (p=0.22). There was no visceral injury in groups. CONCLUSIONS: This randomized study showed that totally ultrasonic had the same outcomes of fluoroscopically csPCNL. Ultrasonography can be an alternative rather than fluoroscopy in PCNL. We believe that more randomized studies are needed to allow endourologists to use sonography rather than fluoroscopy in order to avoid exposition to radiation.

Complete supine PCNL: ultrasound vs. fluoroscopic guided: a randomized clinical trial

ABSTRACT Introduction and Hypothesis: To compare complications and outcomes of complete supine percutaneous nephrolithotomy (csPCNL) with ultrasound guided and fluoroscopically guided procedure. Materials and Methods: In this randomized clinical trial study from January 2009 to September 2010, 26 of 51 patients with renal stones underwent csPCNL with ultrasonographic guidance in all steps of the procedure (group A), and the other 25 patients underwent standard fluoroscopically guided csPCNL (group B). All of the patients underwent PCNL in the complete supine position. Statistical analysis was performed with SPSS16 software. Results: Mean BMI was 28.14 in group A and 26.31 in group B (p=0.30). The mean stone burden was 26.48 and 30.44 in groups A and B, respectively (p=0.20). The stone free rate was 88.5% in group A and 75.5% in group B, that was no significant (p=0.16). Overall 2 patients (7.7%) in group A and 6 patients (24%) in group B had complications (p=0.11). Mean operative time in group A was 88.46 minutes, and in group B it was 79.58 minutes (p=0.39). Mean hospital stay was 69.70 and 61.79 hours in group A and B, respectively (p=0.22). There was no visceral injury in groups. Conclusions: This randomized study showed that totally ultrasonic had the same outcomes of fluoroscopically csPCNL. Ultrasonography can be an alternative rather than fluoroscopy in PCNL. We believe that more randomized studies are needed to allow endourologists to use sonography rather than fluoroscopy in order to avoid exposition to radiation.

Factors affecting complications according to the modified Clavien classification in complete supine percutaneous nephrolithotomy.

INTRODUCTION: An increase in percutaneous nephrolithotomy (PCNL) has been accompanied by an increase in complications. We identified the parameters affecting the severity of complications using the modified Clavien classification (MCC). METHODS: From 2008 to 2013, 330 patients underwent complete supine PCNL using subcostal access, one-shot dilation, rigid nephroscopy, and pneumatic lithotripsy. We assessed the impact of the following factors on complication severity based on the MCC: age, gender, body mass index, hypertension, diabetes, previous stone surgery and extracorporeal shock wave lithotripsy, preoperative hemoglobin, renal dysfunction (creatinine >1.4 mg/dL), preoperative urinary tract infection, anatomic upper urinary tract abnormality (AUUTA), significant (moderate-severe) hydronephrosis, stone-related parameters (opacity, number, burden, location, staghorn, complex stones), anesthesia type, kidney side, imaging and calyx for access, tract number, tubeless approach, operative time, postoperative hemoglobin, and hemoglobin drop and stone-free results. RESULTS: The complication rate was 19.7% (MCC: 0=80.3%, I=6.4%, II=11.2%, ≥III=2.1%). On univariate analyses, only the following factors affected MCC: gender, preoperative hemoglobin, AUUTA, significant hydronephrosis, imaging for access, calyx for access, tract number, postoperative hemoglobin, hemoglobin drop and stone-free result. Renal dysfunction was accompanied by higher complications, yet the results were not statistically significant. Multivariate logistic regression analysis demonstrated renal dysfunction, absence of significant hydronephrosis, AUUTA, multiple tracts, lower postoperative hemoglobin, and higher postoperative hemoglobin drop as the significant parameters which affected MCC and predicted higher grades. The paper's limitations include a low number of cases in the higher Clavien grades and some subgroups of variables, and not applying some techniques due to surgeon preference. INTERPRETATION: Many of the complete supine PCNL complications were in the lower Clavien grades and major complications were uncommon. Renal dysfunction, AUUTA, significant hydronephrosis, tract number, postoperative hemoglobin, and hemoglobin drop were the only factors affecting MCC.

Intra-operative stone culture as an independent predictor of systemic inflammatory response syndrome after percutaneous nephrolithotomy.

To evaluate the correlation between preoperative urine culture and stone culture findings during PCNL and choosing the appropriate antimicrobial treatment of patients with urinary tract infection or SIRS after PCNL. From April 2007 to March 2008, 51 patients aged 24-66 years underwent PCNL under general anesthesia. Statistical analysis was performed using SPSS software (v.18), the Kolmogorov-Smirnov test, Student's t test, and the Chi square or Fisher's exact tests. Before operation, 11 patients (21.6 %) had positive urine culture. Sixteen patients (31.4 %) had positive stone culture during operation. SIRS occurred in 13 patients (25.5 %). In female group (10 cases, 45.5 %), SIRS was significantly higher than male group (3 cases, 10.3 %) (P = 0.008). Positive stone culture was significantly more prevalent in cases with positive pre-operative urine culture than cases with negative pre-operative urine culture (P = 0.023). But positive stone culture in group with SIRS, was significantly more common than group without SIRS (P = 0.001). Also positive stone culture in female group had significantly higher than male group (P = 0.003). We found a significant, tenfold increase in the risk of developing SIRS after PNCL, only in patients with positive stone culture (OR = 9.96; 95 % CI = 2.37-41.85, P = 0.002). Positive stone culture is a significant predictor of SIRS after PCNL, regardless of other related factors. Therefore, in order to avoid using blind empirical antibiotic regimen and to reduce the risk of subsequent microbial resistance due to use of prevalent broad-spectrum antibiotics, it would be wise to choose appropriate antibiotic therapy based on the results of intraoperative stone culture.

Bipolar transurethral vaporization: a superior procedure in benign prostatic hyperplasia: a prospective randomized comparison with bipolar TURP.

OBJECTIVE: To compare the outcomes of bipolar transurethral vaporization of the prostate (TUVP) with bipolar transurethral resection of the prostate (TURP). MATERIALS AND METHODS: In a prospective randomized trial, 88 patients with moderate to severe lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) underwent bipolar TUVP (N = 39) or bipolar TURP (N = 49) from October 2010 to November 2011. The inclusion criteria were age > 50 years, prostate volume of 30-80 mL, serum PSA < 4 ng/mL, IPSS ≥ 20, Qmax ≤ 10 mL/s and failed medical therapy. The perioperative and postoperative outcomes were evaluated and the IPSS and Qmax were assessed preoperatively and 3 months after procedure in all cases. RESULTS: Both groups were similar in patient age, prostate volume, preoperative IPSS and Qmax. The TUVP group had significantly lower mean values of operative time, hospital stay, catheterization period, irrigation fluid volume and serum hemoglobin, creatinine, sodium and potassium changes compared with TURP group. No significant differences were seen between two groups regarding complications (TUVP = 10.3%; TURP = 12.2%) and modified Clavien classification of complications. No TUR syndrome, obturator reflex or epididymitis occurred in both groups. Re-hospitalization and transfusion due to clot retention (N = 2) and urethral stricture (N = 1) were reported only in the TURP group. Three patients experienced urinary retention after catheter removal in the TUVP group. Two patients were re-catheterized temporarily and one patient required repeat bipolar TUVP. Three months after surgery, two groups had significant improvement in IPSS and Qmax. But the TUVP group had significantly lower IPSS and higher Qmax than TURP group. CONCLUSIONS: Bipolar TUVP is a safe, effective and low cost procedure among minimally invasive surgeries of BPH. Compared with bipolar TURP, the bipolar TUVP had similar complications, better perioperative and postoperative outcomes, superior hemostasis and higher efficacy.

Bipolar transurethral vaporization: a superior procedure in benign prostatic hyperplasia: a prospective randomized comparison with bipolar TURP

Objective To compare the outcomes of bipolar transurethral vaporization of the prostate (TUVP) with bipolar transurethral resection of the prostate (TURP). Materials and Methods In a prospective randomized trial, 88 patients with moderate to severe lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) underwent bipolar TUVP (N = 39) or bipolar TURP (N = 49) from October 2010 to November 2011. The inclusion criteria were age > 50 years, prostate volume of 30-80mL, serum PSA < 4ng/mL, IPSS ≥ 20, Qmax ≤ 10mL/s and failed medical therapy. The perioperative and postoperative outcomes were evaluated and the IPSS and Qmax were assessed preoperatively and 3 months after procedure in all cases. Results Both groups were similar in patient age, prostate volume, preoperative IPSS and Qmax. The TUVP group had significantly lower mean values of operative time, hospital stay, catheterization period, irrigation fluid volume and serum hemoglobin, creatinine, sodium and potassium changes compared with TURP group. No significant differences were seen between two groups regarding complications (TUVP = 10.3%; TURP = 12.2%) and modified Clavien classification of complications. No TUR syndrome, obturator reflex or epididymitis occurred in both groups. Re-hospitalization and transfusion due to clot retention (N = 2) and urethral stricture (N = 1) were reported only in the TURP group. Three patients experienced urinary retention after catheter removal in the TUVP group. Two patients were re-catheterized temporarily and one patient required repeat bipolar TUVP. Three months after surgery, two groups had significant improvement in IPSS and Qmax. But the TUVP group had significantly lower IPSS and higher Qmax than TURP group. Conclusions Bipolar TUVP is a safe, effective and low cost procedure among minimally invasive surgeries of BPH. Compared with bipolar TURP, the bipolar TUVP had similar complications, better ...

Effects of varicocele repair on spontaneous first trimester miscarriage: a randomized clinical trial.

PURPOSE: To evaluate the effects of varicocelectomy on semen parameters, pregnancy rates, and live birth in couples with first term recurrent miscarriage. MATERIALS AND METHODS: One hundred and thirty-six women with recurrent miscarriage were recruited into this study. All of the husbands had normal semen parameters according to World Health Organization criteria and clinical varicocele. In order to evaluate the causes of recurrent pregnancy loss, we looked for chromosomal abnormalities and endocrine, chronic inflammatory, and infectious diseases. Both groups were well matched according to male/female age, varicocele grade, and smoking history. These couples were assigned randomly into two groups: group one (n = 68), in which male partners underwent varicocele repair, and group two (n = 68), which underwent expectant therapy. All of the couples were followed up monthly up to 12 months. All of the women who conceived were followed up until delivery. In each 3-month follow-up visits, two semen analyses were performed. RESULTS: Mean sperm concentration, sperm progressive motility, and sperm with normal morphology improved significantly after elapsing 6 months from varicocelectomy by 75.0%, 15.9%, and 14.3%, respectively, versus the expectant group (P < .01). The overall pregnancy rate was 44.1% and 19.1% within a 12-month period in groups 1 and 2, respectively (P = .003). Of women who conceived in groups 1 and 2, 13.3% and 69.2% developed miscarriage (P = .001). Sperm density/mL (r = 0.072; P = .001), time elapsed from varicocelectomy (r = 0.068; P = .001), and female age (r = -0.062; P = .002) were three most significantly related independent factors to pregnancy rate by multiple regression analysis. CONCLUSION: Varicocelectomy improves semen quality, increases pregnancy rate, and decreases miscarriage rate significantly. Further controlled studies to confirm our results seem warranted.

Comparative study of hemodynamics electrolyte and metabolic changes during prone and complete supine percutaneous nephrolithotomy.

BACKGROUND: Nowadays Percutaneous Nephrolithotomy (PCNL) is performed in prone and supine positions. Physiologic solutions should be used to irrigate during PCNL. Irrigation can cause hemodynamic, electrolyte and acid-base changes during PCNL. OBJECTIVES: The current study aimed to compare the electrolyte, hemodynamic and metabolic changes of prone and complete supine PCNL. PATIENTS AND METHODS: It was a randomized clinical trial study on 40 ASA class I and II patients. Twenty of patients underwent prone PCNL (Group A) and the other twenty underwent complete supine PCNL (Group B). The two groups received the same premedication and induction of anesthesia. Blood pressure (systolic, diastolic and mean) and pulse rate were recorded before, during and after anesthesia and Hb, Hct, BUN, Cr, Na, and K were also measured before and after operation in the two groups. The volume of irrigation fluid, total effluent fluid (the fluid in the bucket and the gazes) and volume of absorbed fluid were measured. RESULTS: There were no significant differences in Na, K, BUN, Cr, Hb and Hct between the two groups. Absorption volume was significantly different between the two groups (335 ± 121.28 mL in group A and 159.45 ± 73.81 mL in group B, respectively) (P = 0.0001). The mean anesthesia time was significantly different between the two groups (P = 0.012). There was a significant difference in bleeding volume between supine and prone PCNL (270.4 ± 229.14 in group A and 594.2 ± 290 in group B, respectively) (P = 0.0001). Mean systolic blood pressure during operation and recovery was 120.2 ± 10.9 and 140.7 ± 25.1 in group B, and 113.4 ± 6.4 and 126.2 ± 12.7 in group A, respectively. Systolic blood pressure between the two groups during operation and recovery was significantly different (P = 0.027 and P = 0.022, respectively). Mean diastolic blood pressure in supine group during operation and recovery was 80.53 ± 7.57 and 95.75 ± 17.48, and 73.95 ± 3.94 and 83.4 ± 12.54 in prone group, respectively. Diastolic blood pressure was significantly different between the two groups. It was 80.55 ± 7.57 and 95.75 ± 17.48, respectively during operation and recoveryin the supine group and 73.95 ± 3.94 and 83.4 ± 12.54 in the prone group, respectively (P = 0.001 and P = 0.014, respectively), but there was no significant difference between the pulse rate mean value of the two groups. CONCLUSIONS: The electrolyte and metabolic changes were not significantly different between the two groups, and although fluid absorption in prone group was more than that of the complete supine group, there was no significant difference between the two groups. Considering advantages of complete supine PCNL such as less hemodynamic changes (less hypotension, less fluid absorption and less duration of operation) this kind of PCNL was recommended.

Supine percutaneous nephrolithotomy: pro.

PURPOSE: To share the experience of the authors with the urological family in the world by the review of literature on supine percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: We have searched all the available databases, including PubMed or MEDLINE and Embase Biomedical Database to find any English articles related to supine PCNL from 1998 to 2010. Of 17 studies, 11 were case series and 6 were comparative. RESULTS: A total of 1914 patients were studied. Only the results of mean operation time were significant. Supine PCNL offers several advantages, including less operation time, less patient handling, needing only one drape, easier access to the urethra and upper calyces, facilitation of drainage of stone fragment with the Amplatz sheath, less anterior kidney displacement due to lying the kidney in its normal anatomical position, less risk of the colon injury, more tolerable for the patients with pulmonary or cardiovascular disease, and better for morbid obese patients. The overlap density of the vertebrae in the semi-supine position can be avoided. Furthermore, the fluoroscopy tube is far from the puncture site; thus, the space is open for the surgeon to work and the surgeon can perform the procedure in a more comfortable seated position. CONCLUSION: The study showed that PCNL in the supine position is feasible. Although supine PCNL has numerous advantages, it is not routine in many surgical centers throughout the world. The practice of supine PCNL will be popular when the academic centers be encouraged to start it.

Kidney displacement in complete supine PCNL is lower than prone PCNL.

To compare the amount of the kidney displacement in the complete supine percutaneous nephrolithotripsy (PCNL) to the prone PCNL during getting renal access. Thirty-three patients were randomly divided into two groups. The patients in group A were placed in the complete supine position and the patients in group B in the prone position. Amounts of the kidney displacement in three states and other data were analyzed. The mean amount of the kidney displacement in the complete supine PCNL was 10.1 ± 7.9 mm in stage 1, 10.7 ± 8.28 mm in stage 2 and 12.2 ± 10.4 mm in stage 3. The mean amount of the kidney displacement in prone PCNL was 16.6 ± 5.8 mm in stage 1, 16.2 ± 6.3 mm in stage 2 and 17.6 ± 6.7 mm in stage 3. In stages 1 and 2, a significant difference between the two groups derived from the mean amount of the kidney displacement, but the difference was not statistically significant in stage 3. Adjusted for age, gender, BMI, stone burden and position of PCNL, prone position was a predictor caused significantly more displacement in all three stages. Among other predictors, only BMI had a significant effect on the amount of the kidney displacement (in stages 2 and 3). Performing PCNL in the complete supine position is safe and effective and leads to less kidney displacement during getting renal access and therefore, it may be considered in most patients requiring PCNL.

Open surgery, laparoscopic surgery, or transureteral lithotripsy--which method? Comparison of ureteral stone management outcomes.

BACKGROUND AND PURPOSE: The optimal treatment option for ureteral calculi is a controversial issue. In this study, we present our experience of 60 patients, divided into three groups, who were treated using open surgery, laparoscopic surgery, or transureteral lithotripsy (TUL). PATIENTS AND METHODS: We enrolled 60 patients who had upper ureteral calculi >l0 mm in diameter from June 2008 to August 2009 in our center. In a prospective study, preoperative and postoperative data were evaluated, and for statistical analyses, the chi-square test, one-way analysis of variance, and post hoc test were used. RESULTS: The mean operative time was 70, 191, and 162.5 minutes in the TUL, laparoscopic, and open groups, respectively. The mean hospital stay was 1.65, 4.2, and 4.35 days in the three groups, respectively. The stone-free rate was 90%, 95%, and 100% in the three groups, respectively. Flank pain was reported as 15%, 5%, and 15%, in the three groups, respectively. Hemoglobin decrease necessitating blood transfusion was not reported in the TUL and laparoscopic groups, but blood transfusion was reported in 15% in the open group. The lowest dose of analgesic was used in the TUL group. There was no damage to the ureter and adjacent organs and wound infection in the three groups. CONCLUSION: Our study showed that the complications after laparoscopic surgery were lower than in open surgery. We recommend laparoscopic surgery for upper ureteral stones >1 cm because of lower postoperative complications, shorter hospital stay, and shorter time to convalescence, and better cosmetic results.

Complete supine percutaneous nephrolithotomy (csPCNL) in patients with and without a history of stone surgery: safety and effectiveness of csPCNL.

To determine the effects of previous stone surgery on the results of complete supine percutaneous nephrolithotomy (csPCNL), we reviewed 81 patients undergoing csPCNL at our center between March 2008 and March 2009. The principal aim in our study was whether prior renal surgery affects the outcome of PCNL. The results of the study were analyzed using SPSS 11 software. Our patients were divided to in two groups. Group 1 consisted of patients with a previous history of renal stone surgery and group 2 consisted of patients without history of renal surgery. Mean operative time in group 1 was 98.75 ± 56.31 min, and in group 2 99.71 ± 45.9 min (p = 0.93). Bleeding requiring transfusion occurred in four (14.2%) patients in group 1, and in eight (15.09%) patients in group 2 (p = 0.826). Fever was detected in no patients in group 1, and in four (7.5%) patients in group 2 (p = 0.136). Postoperative hematoma was seen in one (3.5%) patient in group 1 and in no patient in group 2 (p = 0.166). Other major complications including extravasations, sepsis, pleural effusion, pelvis perforation, and visceral organ trauma were not seen in any groups. This is the first experience of csPCNL in patients with and without a previous history of renal surgery. We found that there was no difference in results between the two groups that underwent complete supine PCNL. So csPCNL in patients with a history of stone surgery can be safe and effective. csPCNL offers the potential advantages of less patient handling, easier access to the urethra, easier possibility of changing spinal or regional anesthesia to general anesthesia if needed, better airway control and less hazard, especially for patients with compromised cardiopulmonary function, morbid obesity, or those who require a prolonged procedure and easier access to upper calyx. Its popularity is still minimal in the field of urology as a whole, because of fear of colon injury and a lack of training in this position in educational centers.

Is there a role for tamsulosin after shock wave lithotripsy in the treatment of renal and ureteral calculi?

INTRODUCTION: Our study aimed at defining the role of tamsulosin as adjunctive therapy after extracorporeal shock wave lithotripsy (ESWL) in patients with stones in the kidney and ureter. MATERIALS AND METHODS: A placebo-controlled, randomized, double-blind clinical trial prospectively performed between February 2008 and September 2009 on 150 patients with 4-20 mm in diameter renal and ureteral stones referred to our ESWL center. After ESWL, all patients randomly assigned to two groups (placebo and tamsulosin). The drugs administration was started immediately after ESWL and was continued for a maximum of 30 days. RESULTS: From 150 patients, 71 in control group and 70 in case group completed the study. Of 71 patients (60.56%) in control group, 43 patients became stone free; and other patients (39.44%) did not succeed in stone expulsion during 12 weeks after ESWL. In case group of 70 patients (71.4%), 50 patients became stone free. Time of stone passage in most of the patients happened between 20th and 30th day in control group (32.6%) and between 10th and 20th day (50%) in case group after ESWL. There is no statistically significant difference between stone passage in two groups (p = 0.116) and location of stone (p = 0.114), but there is statistically significant difference in time of stone passage from onset of treatment in case and control groups (p = 0.002). CONCLUSION: At last, this study suggested that tamsulosin facilitate earlier clearance of fragments after ESWL.

Is complete supine percutaneous nephrolithotripsy feasible in all patients?

Although complete supine percutaneous nephrolithotomy (csPCNL) is routine in some surgical centers throughout the world, its popularity in the field of urology due to a deficiency in its training in educational centers, as a whole, is still minimal. We evaluated the outcomes of tubeless csPCNL in this study. This study was a clinical trial, conducted by one surgical team from January 2009 to January 2010, on 117 patients in complete supine position. Percutaneous access was created under fluoroscopic or ultrasonographic guidance in complete supine position. All patients underwent csPCNL without nephrostomy tube (tubeless). Stone disintegration was performed with pneumatic lithotripsy. Pre- and post-operative data of patients were evaluated. The mean operative time was 98 min. The mean reduction in hemoglobin level was 1.5 g/dl. A total of 129 punctures (105 single and 12 double) was performed. The ureteral catheter was left for 1-3 days. The mean hospital stay was 3.7 days. The stone-free rate was 77.77%. Seventeen patients required blood transfusion. Eight patients had fever. Fistula, extravasation or wound infection did not occur. This study demonstrated that csPCNL is a good option for all patients. Furthermore, csPCNL offers potential advantages including better urethral access, less handling of patients, better control of the airway during procedures and reducing overall operative time, a surgeon seated more comfortably, no density overlap with vertebra, easier access to upper calyces, more rapid access to the airway with less hazard, especially in patients with compromised cardiopulmonary function and morbid obesity.

Totally ultrasound versus fluoroscopically guided complete supine percutaneous nephrolithotripsy: a first report.

PURPOSE: As endourologists are highly exposed to X-ray irradiation during endourologic surgeries, the use of alternative methods for entrance into the collective system and dilatation of tract could be safe and less expensive. MATERIALS AND METHODS: Percutaneous access was created under ultrasonographic guidance in the complete supine position without flank elevation in 14 patients (group A) and under fluoroscopic guidance in the complete supine position without flank elevation in 14 patients (group B). We performed all steps of the complete supine percutaneous nephrolithotripsy (PCNL) with ultrasonographic guidance in group A. RESULTS: In group A, mean age of patients was 46.5 ± 15.54 years and in group B 45.21 ± 10.72 years. The mean stone burden was 51.07 and 41.92 mm in groups A and B, respectively (p = 0.54). Mean operative time in group A was 88.93 ± 33.29 minutes and in group B it was 79.29 ± 16.74 minutes (p = 0.34). Stone-free rate was 78.6% in group A and 71.4% in group B (p = 0.66). Hospital stay was 85.88 ± 17.25 and 80.20 ± 17.71 hours in groups A and B, respectively (p = 0.12). Transfusion was done in 1 (7.14%) patient in group A and in 3 (21.43%) patients in group B (p = 0.28). Fever was detected in 2 (14.28%) patients in group A and in 1 (7.14%) patient in group B (p = 0.54). In our study, there were no pleural effusion, postoperative hematoma, renal pelvis perforation, and visceral organ trauma in any groups. CONCLUSION: We showed that totally ultrasound-guided complete supine PCNL is safe and feasible even in reoperative patients. It has certain advantages such as elimination of X-ray exposure to the surgeon and staff of the operating room, avoidance of contrast material administration, identification of all the tissue between the skin and kidney, and the energy expenditure of the surgeon and other staff of the operating room is decreased as it is not necessary to wear a lead shield.