Supine Percutaneous Nephrolithotomy in the Galdako-Modified Valdivia Position: A High-Volume Single Center Experience.

OBJECTIVE: To describe the technique and outcomes of supine percutaneous nephrolithotomy (PCNL) in the Galdako-modified Valdivia position. MATERIALS AND METHODS: Prospective data were collected from 303 patients undergoing PCNL in the Galdako-modified Valdivia position at our institution between 2007 and 2015. We report our technique with outcomes of operative times, stone-free rate (SFR), and complications. RESULTS: A total of 202 solitary stones with a mean size of 17.19 ± 5.82 mm, 42 stones in multiple calices, and 57 staghorns were treated. Mean operative time was 79.79 ± 35.72 minutes. A total of 244/303 (80.5%) patients had clearance or <2 mm stone on postoperative CT. Minor complications (Clavien-Dindo Classification [CDC] 1-2) occurred in 59 (19.5%) cases and major complications (CDC ≥3) occurred in 22 (7.3%) cases. Five (1.7%) cases required postoperative blood transfusion for bleeding complications. CONCLUSION: We demonstrate that PCNL in a high-volume center to be safe and efficacious in the Galdalko-modified Valdivia position. We show equivalent SFR and complication rates to large studies of prone PCNL, with potential to decrease operative time. In particular, supine position is optimum for obese or high-risk patients with complex stone disease, because of ease of positioning and lower theoretical risk of anesthetic complications.

Impact of intravenous furosemide on flow rate characteristics and clinic waiting times.

OBJECTIVE: To assess the impact of a single dose of i.v. furosemide on clinic waiting times and urinary flow rate parameters in a group of symptomatic men. METHODS: Sixty-two consecutive men attending a prostate assessment clinic were prospectively entered into the study. They were then randomized to receive 10 mg of i.v. furosemide or to drink oral fluids only, as per standard protocol. Flow rate parameters and clinic waiting times were recorded. RESULTS: The clinic waiting time was significantly reduced by the administration of i.v. furosemide compared to oral fluid alone (81 vs 36 min; P < 0.0001) without any alteration in flow rate characteristics. Interestingly, although there was no statistically significant difference between the voided volumes in both groups (251 vs 313 mL; P = 0.115) all of the patients given furosemide voided a volume of over 150 mL, where as almost a third (10/32) of those receiving oral fluid alone did not achieve this. There were no adverse events following the administration of i.v. diuretic. CONCLUSION: A single dose of i.v. furosemide dramatically reduces the overall clinic waiting time without inducing statistically significant changes in flow rate parameters. Indeed, none of the patients receiving furosemide voided less than 150 mL. We would thus recommend this practice be considered as an alternative to standard uroflowmetry protocols.