Rapid axial roll test outperforms alternative positional tests in identifying the affected ear in HSC-BPPV: an observational cohort study.

Purpose: To evaluate the utility of supine roll test (SRT) and alternative positional tests, such as head-shaking test (HST), seated supine positioning test (SSPT), bow and lean test (BLT), and rapid axial roll test (RART) in determining the affected semicircular canal of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV). Methods: In an observational cohort study, 553 patients diagnosed with HSC-BPPV were divided into five groups in terms of different positional tests received: SRT group (n = 110), HST+ SRT (n = 112), BLT + SRT (n = 114), SSPT+SRT (n = 108) and RART+SRT (n = 109). The same method was used for the last four groups: The patients were first subjected to different alternative positional tests and then to SRT, and the nystagmus was observed separately to determine the affected side. The primary outcomes compared included the accuracy and sensitivity of these tests in the determination of the affected semicircular canal in HSC-BPPV. Results: Patients with nystagmus elicited by positional tests accounted for 84.99% (470/553). The elicitation rate of nystagmus of SRT was lowest, being 77.27% (85/110). The elicitation rate of nystagmus were higher in the test groups than in the control group, and RART+SRT group yielded the highest elicitation rate of nystagmus (95.41%, 104/109). Among the alternative positional tests, RART attained the highest elicitation rate of nystagmus (101/109, 92.66%). Comparison between alternative positional tests and SRT, RART and SRT showed obviously better agreement in determining the affected semicircular canal (85.45%, 96/109) and eliciting nystagmus (95.41%, Kappa = 0.642), but no difference was found in curative effect when the affected side was accurately determined (χ2 = 1.618, p = 0.655). Conclusion: All alternative positional tests are helpful for eliciting nystagmus in patients with HSC-BPPV, and the significant advantages of RART include high-sensitivity in eliciting nystagmus and high accuracy in determining the affected semicircular canal, which provided objective support for the correct diagnosis of HSC-BPPV and the successful reduction of otolith.

Does Pelvic Floor Muscle Exercise Change the Hemodynamic Responses of the Inferior Vena Cava in Pregnant Women? A Prospective-Controlled Study.

INTRODUCTION AND HYPOTHESIS: This study was aimed at exploring the immediate impacts of pelvic floor muscle exercises (PFMEs) on various maternal physiological parameters in pregnant women. METHODS: The study included a total of 52 women, 26 pregnant (Pregnant group: 28.04±6.01 years; 26.83±3.81 kg/m2) and 26 nonpregnant (Control group: 29.42±5.73 years; 25.41±3.03 kg/m2) individuals. All women received PFME as follows: PFME was performed for 5 min (6-s holding contraction, 10 s of relaxation, 3 rapid PFM contractions). Evaluations were conducted before, immediately after, and 5 min post-exercise, with measurements including inferior vena cava (IVC) diameters and pulsatility index, blood pressure, oxygen saturation, and heart rates. Two-way analysis of variance was performed for group and time comparisons in repeated measurements. RESULTS: In both groups, the IVC collapsibility index values were lower 5 min after exercise, although this decrease, although clinically significant, did not reach statistical significance (p = 0.057). Post-exercise systolic blood pressure significantly decreased in both groups, whereas diastolic blood pressure decreased significantly in the pregnant group (p = 0.001, p = 0.023). CONCLUSIONS: The study found no statistically significant changes in the collapsibility index of the IVC after PFME but observed a clinically suggestive decrease. The clinical decrease in the collapsibility index can be interpreted as PFME in the supine position increasing venous return. Additionally, PFME was found not to alter maternal and fetal heart rates but contributed to the decrease in maternal systolic and diastolic blood pressure. Our study supports the view that the acute effects of PFME neither induce fetal stress nor pose maternal risks.

Perfection is the enemy of good. A Letter to the Editor on "Orthostatic hypotension in Parkinson's disease: Sit-to-stand vs. supine-to-stand protocol and clinical correlates".

Orthostatic hypotension (OH) is prevalent in Parkinson's disease. Lim et al. report a higher OH detection rate with the supine-to-stand test compared to the sit-to-stand test. While they favour the supine-to-stand test, we argue that the sit-to-stand test, with adjusted blood pressure thresholds, remains a valuable and practical screening tool.

First 100 Reported Cases of Supine Percutaneous Nephrolithotomy in Malaysia: An Alternative Effective and Safe Approach to Treat Renal Stones.

Background: Supine percutaneous nephrolithotomy (s-PCNL) offers great benefits from urological and anaesthetic points of view. We present the first evaluation of the outcomes of s-PCNL in Malaysia. Our aim was to explore the safety and efficacy of s-PCNL. Methods: Institutional review board approval was obtained from the National Medical Research Register (NMRR ID-21002225-WLP). We retrospectively reviewed 115 patients with renal pelvis stones who underwent single renal access during s-PCNL between November 2020 and May 2023. Patients who underwent simultaneous ipsilateral or contralateral endourological procedures were included. The data were analysed to determine stone-free rates (SFR), major complication rates, blood transfusion rates, operative times and lengths of hospital stay (LOS). Results: The SFR was higher for the single middle calyceal renal access (MCA) group than for the lower calyceal renal access (LCA) or upper calyceal renal access (UCA) groups (OR: 1.76; 95% confidence interval [CI]: 0.63, 4.92). In total, 0, 1 and 2 patients had major complications in the UCA, MCA and LCA groups, respectively (P = 0.453). One of the 115 patients (0.9%) needed blood transfusion. Subgroup analysis revealed mean operative times of 76.3 min and 78.6 min for patients who underwent sole s-PCNL (PCNL-only group) and those who had simultaneous ipsilateral and contralateral endourological procedures (PCNL-plus group), respectively (P = 0.786). The overall mean LOS was 2.9 days. Conclusion: s-PCNL is a safe and effective alternative treatment for renal stones. We would recommend s-PCNL for patients who require an ipsilateral/contralateral endourological procedure (URS/RIRS) because it is time-efficient. All renal accesses are safe. Single MCA is recommended for complete stone clearance.

Incidence of medical adhesive-related skin injury: a reduction by changing posture.

OBJECTIVE: Medical adhesive-related skin injuries (MARSI), defined as skin damage associated with the use of medical adhesive products or devices, are a common and under-reported condition that compromises skin integrity. The prevention and management of MARSI that can occur around the needle insertion site of a chest wall implantable port in hospitalised patients with a tumour remain challenging issues. The aim of this study was to explore whether the incidence of MARSI could be reduced by changing the body position during dressing changes. METHOD: Participants were recruited between May 2019 and November 2020 in the oncology department of a tertiary hospital. Patients were randomly assigned to Group AB (supine followed by semi-recumbent position) and Group BA (semi-recumbent followed by supine position) with a standard intervening recovery interval of 21-28 days. Assessments for typical MARSI included itching, the combination of erythema and oedema, and blisters in the port area, and were graded according to the level of severity. RESULTS: The itch intensity was significantly lower in phase B (semi-recumbent) compared to phase A (supine) (2.35±1.985 versus 5.31±1.332, respectively; p<0.01). Similarly, the severity of erythema and oedema was less severe when comparing phase B to phase A: grade 0 (64.9% versus 10.5%, respectively); grade 1 (28.1% versus 19.3%, respectively); grade 2 (3.5% versus 7.0%, respectively); grade 3 (1.8% versus 45.6%, respectively); and grade 4 (1.8% versus 17.5%, respectively) (Z=5.703; p<0.01). Blisters were found far less frequently in phase B than phase A (1.8% versus 56.1%, respectively; p<0.01). CONCLUSION: The study provided statistically significant evidence that patients in a semi-recumbent position receiving dressing at a chest wall implantable port had fewer and less severe injection site MARSI than when in a supine position. DECLARATION OF INTEREST: The authors have no conflicts of interest to declare.

Influence of sleep stages on determining positional dependency in patients with obstructive sleep apnea.

Objective: Supine sleep position and rapid eye movement (REM) stage are widely known to aggravate the severity of obstructive sleep apnea (OSA). In general, position-dependent OSA is defined as an apnea-hypopnea index (AHI) at least twice as high in the supine position as in other sleep positions, but it can be misdiagnosed if a certain sleep stage, REM or NREM, is dominant in a specific sleep position. In this study, we investigated the influences of the sleep stages on positional dependency. Methods: The polysomnographic data from 111 OSA patients aged ≥ 18 years (AHI > five events/hour) who slept in both supine and non-supine positions (each ≥ 5% of the total sleep time) were retrospectively analyzed. The overall ratio of non-supine AHI/supine AHI (NS/S AHI ratio) during the entire sleep was compared between specific sleep stages, i.e., REM or NREM sleep. Additionally, the weighted NS/S AHI ratio reflecting the proportion of each sleep time was created and compared with the original NS/S AHI ratio. Results: The mean value of the NS/S AHI ratio did not differ between the entire sleep and the specific sleep stages. However, those ratios in the individual patients showed poor agreement of the NS/S AHI ratios between the entire sleep and the specific sleep stages. The weighted NS/S AHI ratio also demonstrated poor agreement with the original NS/S AHI ratio, mainly due to the discrepancy in mild to moderate OSA patients. Conclusion: The weighted NS/S AHI ratio might help assess precise positional dependency.

Intraperitoneal laparoscopic single-site lymph node dissection in modified supine position during laparoscopic radical nephroureterectomy.

Technique modifications that aim to improve ergonomics of the surgical procedure without repositioning the upper tract urothelial carcinoma patients remain a challenge to urologists. We offer a novel technique to perform intraperitoneal laparoscopic single-site radical nephroureterectomy and pelvic lymph nodes dissection/retroperitoneal lymph nodes dissection in a supine position. Our novel technique is feasible and offers a significant improvement in operative efficiency, particularly in patients with locally advanced disease.

Second-degree atrioventricular block induced by electrical stimulation of transcranial motor-evoked potential: a case report.

BACKGROUND: Although several complications of transcranial motor-evoked potentials (Tc-MEPs) have been reported, reports of arrhythmias during Tc-MEP are very rare. CASE PRESENTATION: A 71-year-old woman underwent transforaminal lumbar interbody fusion under general anesthesia, with intraoperative Tc-MEP monitoring. Preoperative electrocardiography showed an incomplete right bundle branch block but no cardiovascular events in her life. After induction of anesthesia, Tc-MEP was recorded prior to the surgery. During the Tc-MEP monitoring, electrocardiography and arterial blood pressure showed a second-degree atrioventricular block, but it improved rapidly at the end of the stimulation, and the patient was hemodynamically stable. Tc-MEP was recorded seven times during surgery; the incidence of P waves without QRS complexes was significantly higher than before stimulation. The surgery was uneventful, and she was discharged eight days postoperatively without complications. CONCLUSIONS: Our case suggests that electrical stimulation for Tc-MEP can cause arrhythmia. Electrocardiography and blood pressure must be closely monitored during Tc-MEP monitoring.

Comparison of standard percutaneous nephrolithotomy and total tubeless percutaneous nephrolithotomy in the supine position.

PURPOSE: To compare the efficacy, safety and advantages of the total tubeless (TT) percutaneous nephrolithotomy (PCNL) and standard PCNL in the supine position. METHODS: This study was carried out at Izmir Tepecik Health Application and Research Center. A total of 87 patients were examined. Forty-three patients who underwent TT procedure were defined as Group 1, and 44 patients who underwent standard procedure with a nephrostomy tube were defined as Group 2. Two techniques were evaluated with demographic data and outcome parameters. Univariate regression analyses were performed in these data sets for the parameters that predicted the TT procedure. RESULTS: The demographic data of the groups and all characteristics of the stones were similar. When the results were examined, the stone-free rates detected by non-contrast computed tomography (CT) in the postoperative 1st month were similar between the groups. Complication rates and secondary intervention rates were similar. Operation and fluoroscopy times were shorter in group 1, which were not statistically significant. Postoperative hemoglobin decreased, and creatinine values were similar. In Group 1, mean postoperative visual analog scale (VAS) scores and the percentage of VAS reporting > 5 points for pain level measurement were lower and statistically significant. In the univariate analysis of the factors predicting the TT procedure, no significant results were found in any parameter. CONCLUSION: Performing TT PCNL in the supine position in selected patients reduces postoperative pain without affecting the complication rates as in prone PCNL. Our study is the first to compare TT and standard PCNL in supine position.

Bilateral Phrenic Nerve Palsy Associated With Neuralgic Amyotrophy.

Neuralgic amyotrophy (NA) is a multifocal inflammatory neuropathy accompanied by acute pain and muscle atrophy. NA commonly affects the upper extremities, but rarely affects the phrenic nerve. Here, we report a male with neck pain, orthopnea, difficulty sleeping in the supine position, and inability to slurp. His saturated oxygen level decreased from 97% to 86% in the supine position. His right shoulder showed muscle atrophy. Chest X-ray examination in the supine position and a nerve conduction study showed phrenic palsy. We diagnosed it as bilateral phrenic nerve palsy associated with NA. NA sometimes causes phrenic nerve palsy and may cause slurping difficulty.

Comparison of Modified Mallampati Classification in Supine and Sitting Positions to Predict Difficult Tracheal Intubation in Diabetic Patients.

Background: Airway management of patients with long-standing diabetes poses a major challenge for anaesthesiologists due to stiff joint syndrome affecting the atlanto-occipital joint. In certain cases requiring immobilization, the Mallampati test must often be performed in the supine position for obvious reasons. Objectives: Hence, we determined the diagnostic precision (sensitivity and specificity) of the modified Mallampati test in sitting and supine positions among the diabetic population in predicting difficult tracheal intubation. Methods: A single-center prospective observational study on adult diabetic patients undergoing general anesthesia and orotracheal intubation was carried out. An observer recorded the modified Mallampati in the sitting posture during the pre-anesthetic examination. The Mallampati in the supine position was determined while in the operating room, and the difficulty of intubation was noted, and diagnostic precision was calculated. The main objective was to predict a difficult airway by calculating the sensitivity, specificity, positive predictive value, and negative predictive value. Results: Out of the 150 participants, Mallampati grading in a sitting position was correctly able to identify 42.5% of difficult intubation cases, whereas it was 97.5% with Mallampati in the supine position. Mallampati grading in the sitting position was able to correctly identify 89.1% of easy intubation cases, which was 63.6% with Mallampati in the supine position. The correlation of Mallampati in the supine position with CL grading was statistically significant (P < 0.001). Conclusions: Among diabetic patients, the modified Mallampati test in the supine position can be considered a more accurate and sensitive predictor of difficult intubation than the sitting posture.

Longitudinal Volume Assessment of Reconstructed Breast Using Three-Dimensional Measurement: How Do DIEP and LD Flap Change Immediately after Surgery?

Background The deep inferior epigastric perforator (DIEP) and latissimus dorsi (LD) flaps are two widely used autologous breast reconstructions. Despite studies on flap-volume changes, the time of the first measurement is not immediately after surgery. Therefore, this study aimed to investigate the change in volume over time from the immediate postoperative period using a three-dimensional (3D) scanner. Methods Patients who underwent breast reconstruction with a DIEP or LD flap between October 2019 and December 2020 at Showa University Koto Toyosu Hospital were included. The Kinect 3D scanner was used to measure the reconstructed and healthy breast volumes immediately after surgery and at 1, 3, 6, and 12 months. The control group was the healthy side, and the volumes obtained at each time point and ratios (to the immediate postoperative period) were calculated and analyzed using a linear mixed model. Results Of the 25 patients and 26 breasts examined, the postoperative increase in volume ratios was statistically significant in the DIEP flap group, except for the sixth month, but decreased significantly in the LD group. Compared with the control group, the volume ratio was significantly higher up to 3 months in the DIEP flap group and decreased significantly after 3 months in the LD flap group. Conclusions The volume of the LD flap continued to decrease immediately after surgery, whereas the volume of the DIEP flap increased by 10% up to 1M. Therefore, this increase in volume should be taken into consideration in studies where the initial measurements were not taken immediately after surgery.

Approaching the Humerus, Elbow, and Proximal Forearm Using the Trimano Arm Holder.

Upper limb surgeons frequently encounter complex cases involving the proximal humerus, elbow joint, and proximal forearm, both in trauma and elective practice. Given the diverse pathology in these areas, various surgical approaches have been described, each with its advantages, limitations, and specific patient positioning requirements. We describe an operative technique that modifies the use of an existing, commercially available, dynamic pneumatic limb positioner, the TRIMANO FORTIS® (Arthrex, Maquet GmbH), for open and arthroscopic procedures of the elbow, proximal forearm, midshaft, and distal humerus. This technique offers simplicity, reproducibility, and enhanced surgical efficiency.

Nasal Patency Across Seated, Supine, and Recumbent Postures in Individuals With and Without Allergic Rhinitis.

Objectives: This study aimed to investigate the effects of seated, supine, and recumbent postures on nasal resistance in individuals with allergic rhinitis (AR) and healthy controls, which has not been investigated in the past. Methods: A visual analog scale (VAS) assessed subjective nasal obstruction, while acoustic rhinometry and video endoscopy provided objective measures. Sixty participants, comprising 30 AR patients and 30 healthy controls, were evaluated across 4 postures without decongestion: seated, supine, left recumbent, and right recumbent. Results: In patients with AR, we noted no significant changes in subjective nasal blockage under various postures (all P > .18). However, significant reductions of minimal cross-sectional area (mCSA) were found (seated vs supine, P = .014; seated vs left recumbent, P = .001; seated vs right recumbent, P < .001) and significant increases in the inferior turbinate hypertrophy were observed on the dependent side of the nose when in recumbent posture (right nose: seated vs right recumbent, P = .013; left nose: seated vs left recumbent, P = .003). On the contrary, healthy controls experienced increased subjective nasal obstruction (VAS scores: seated vs supine, P < .001; seated vs left recumbent, P = .003; seated vs right recumbent, P < .001), reductions in mCSA (seated vs supine, P = .002; seated vs right or left recumbent, both P = .001), and increased inferior turbinate hypertrophy on the dependent side of the nose (right nose: seated vs right recumbent, P = .003; left nose: seated vs left recumbent, P = .006). Conclusions: Healthy controls reported better nasal patency when shifting from supine or recumbent to more upright or less gravity-dependent seated postures, which was further supported by objective examinations. On the contrary, despite patients with AR not subjectively perceiving increased nasal patency while adopting more upright postures, objective evaluations demonstrated an improvement in their nasal airflow in these less gravity-dependent postures.Level of Evidence: 4.

Propensity Score-Matched Analysis of Perioperative Outcomes of Supine versus Prone Percutaneous Nephrolithotomy.

Objective: To compare the perioperative outcomes of supine and prone percutaneous nephrolithotomy (PCNL). Methods: A retrospective search of a tertiary medical center database yielded 517 patients who underwent supine (n = 91) or prone (n = 426) PCNL between September 2015 and July 2020. Data on demographics, baseline clinical parameters, and stone burden were included as predictors in a logistic regression model, generating a set of propensity scores. Seventy patients after supine PCNL were propensity score-matched 1:1 with patients after prone PCNL and compared for operative time, perioperative complications, system complexity, and stone-free rate. Results: We found that the operative time was significantly shorter in the supine PCNL group than in the prone PCNL group (85.5 ± 25.2 min vs. 96.4 ± 25.8 min, respectively; p = 0.012). The majority of both groups had low-grade (I-II) complexity systems (85.6% and 88.6%, respectively), with no significant difference among all grade groups (p = 0.749). There were no significant differences between the supine and prone PCNL groups in terms of the overall perioperative complication rate (8.6% vs. 4.3%, respectively; p = 0.301) or stone-free rate (74.3 vs. 65.7%, respectively; p = 0.356), while the rate of blood transfusion was significantly higher in the supine group (p = 0.023). Conclusions: In our study, we used propensity score matching to compare patients who underwent PCNL in the supine or prone position, adjusting for selection bias. Supine PCNL was associated with a shorter operative time but a higher blood transfusion rate, with no differences in the overall complication and stone-free rates.

Comparison of supine-prone percutaneous nephrolithotomy methods in the treatment of kidney stones in pediatric patients: prospective randomized study.

Mini-PCNL is one of the most effective surgical methods in the treatment of kidney stones in pediatric patients. In this study, we aimed to compare PCNL in the supine-prone position in pediatric patients (especially operation time, postop complications, hospital stay and stone-free rates).We conducted our study in a randomized and prospective manner. Patients with lower pole stones larger than 1 cm, stones larger than 1.5 cm in the pelvis, upper pole, midpole or multiple locations, and patients who did not respond to ESWL or whose family that preferred mini-PCNL to be the primary treatment were included in the study. Patients with any previous kidney stone surgery, patients with coagulation disorders and patients with retrorenal colon were excluded from the study. Between 2021 and 2023, a total of 144 patients underwent PCNL. 68 of these patients had supine PCNL and 76 prone PCNL. Postoperative Clavien grade1 complication occurred in a total of 7 patients in the prone position; Clavien grade1 complication occurred in 1 patient in the supine position. The mean operation time for prone PCNL was 119.88 ± 28.32 min, and the mean operative time for supine PCNL was 98.12 ± 14.97 the mean hospitalization time in prone PCNL was 3.56 ± 1.12 days, and 3.00 ± 0.85 days in supine PCNL. In conclusion, supine PCNL is a safe and effective method in the treatment of pediatric kidney stones and postoperative complications were observed to be less; the operation time and hospital stay were shorter in supine PCNL.

Postoperative elevated bed header position versus supine in the management of chronic subdural hematoma: a systematic review and meta-analysis.

BACKGROUND: Chronic subdural hematoma (CSDH) is a prevalent type of intracranial hemorrhage. Surgical interventions, such as Twist Drill Craniostomy and Burr Hole Craniostomy, are employed for its treatment. However, limited information exists regarding the impact of postoperative head position (supine vs. elevated) on clinical outcomes. We aim to assess whether patients' head position after surgery influences their prognosis. METHOD: We conducted a PRISMA-compliant systematic review and meta-analysis. Our search encompassed PubMed, Cochrane CENTRAL, Scopus, Web of Science, and Embase databases to identify relevant published studies. Data were meticulously extracted, pooled using a fixed model, and reported as risk ratios (RR) with 95% confidence intervals (CI). Statistical analysis was performed using R and Stata MP v.17. RESULTS: Five studies involving 284 patients were included in our meta-analysis. We focused on three primary clinical outcomes, comparing the supine and elevated header positions. Notably, there was no statistically significant difference between the supine and elevated positions in terms of recurrence rate (RR 0.77, 95% CI [0.44, 1.37]), second intervention for recurrence (RR 1.07, 95% CI [0.42, 2.78]) and postoperative complications (RR 1.16, 95% CI [0.70, 1.92]). CONCLUSION: Current studies have proved no difference between supine and elevated bed header positions regarding recurrence rate, second intervention for recurrence, and postoperative complications. Future RCTs with long-term follow-ups are recommended.

Effects of the low Fowler's sleep position and methazolamide treatment on sleep bruxism: A randomized controlled trial.

Intracranial pressure is one of the determinants of sympathetic activities, and sleep bruxism is associated with increased sympathetic activities. This study aimed to investigate effects of the low Fowler's sleep position and methazolamide treatment on the occurrence of rhythmic masticatory muscle activities/sleep bruxism episodes in patients with sleep bruxism in a randomized controlled trial. Polysomnographic recordings were performed on the patients with sleep bruxism sleeping in the low Fowler's (15°-30°) or supine position (n = 11), and with methazolamide or placebo treatment (100 mg, 3-4 hr before bedtime, P.O., n = 9), and changes in sleep variables and heart rate variance during sleep in the low Fowler's position or with methazolamide treatment were determined. Sleep bruxism index, number of masseter muscle electromyographic bursts per hour of sleep, ratio of rhythmic masticatory muscle activities/sleep bruxism duration to the total sleep duration, index of total limb movements, index of limb movements with rhythmic masticatory muscle activities, and number of sleep bruxism clusters per hour of sleep in the low Fowler's position and after methazolamide intake were significantly smaller (p < 0.05-0.001) than those in the supine position and after placebo intake, respectively. The low-frequency heart rate variance powers during non-rapid eye movement sleep stage 2 (N2) in the low Fowler's position and with methazolamide treatment were significantly lower (p < 0.05) than those during sleep in the supine position and with placebo treatment, respectively. In conclusion, sleep in the low Fowler's position and methazolamide treatment were associated with significant decreases in the occurrence of rhythmic masticatory muscle activities/sleep bruxism episodes, which might be due to a reduction in intracranial pressure and sympathetic activities mainly during non-rapid eye movement sleep stage 2.

Simplified biplanar (0-90°) versus monoplanar renal puncture technique in flank free modified supine percutaneous nephrolithotomy regarding outcomes and learning curve: Randomized clinical trial.

Objective: To evaluate the learning curve and the success rate of the biplanar (0-90°) puncture technique in the flank-free modified supine position in comparison to the monoplanar puncture technique. Methods: Randomized controlled study included 68 patients more than 18 years with renal stones more than 2 cm from August 2021 to August 2022 were randomly classified by closed envelope method into group A (34 patients) scheduled for monoplanar renal puncture technique in flank-free modified supine PCN. Meanwhile, group B (34 patients) was scheduled for the 0-90° simplified fluoroscopic puncture technique. Morbid obese patients and patients with contraindications for PNL were omitted from the study. Results: There was no significant difference between both groups regarding stone distribution and patients' demographic data. There was a significant difference between both groups regarding puncture attempts. In 88.2% of patients in group B (Biplanar group), the success of renal puncture occurred from the 1st puncture attempt while in 11.2% of patients in group A (monoplanar group). There was a statistically significant difference between both groups in fluoroscopy time and total operation time (p-value <0.001 & p-value: 0.001), respectively. The stone-free rate was 85.2% vs. 88.2% in both groups, respectively, without significant difference. In this study puncture, attempt trials and puncture time were used as indicators for the easiness and rapid educability of the biplanar (0-90°) fluoroscopic guided renal puncture technique. In the biplanar (0-90°) group after 24 cases, the learning curve had reached the plateau. Conclusion: Biplanar (0-90°) puncture technique in flank-free modified supine position allows an easy puncture technique with an easy learning curve without affecting the success rate or complication rate.

Supine tubeless upper pole PCNL under spinal anaesthesia: Safety, feasibility and outcomes from a tertiary endourology centre.

Objective: Supine Percutaneous Nephrolithotomy (PCNL) is being taken up by many urologists in recent times, but there is a tendency to shift to prone PCNL for upper pole puncture. We analyzed the safety, feasibility and outcomes of upper pole access in Supine Percutaneous Nephrolithotomy (sPCNL). Materials and methods: A retrospective review of all patients undergoing sPCNL at a tertiary care center was done from January 2021 to December 2022. Data collection was done from the maintained imaging, laboratory and hospital records. All cases with complete data on upper pole access were included. Data analysis was done with Xlstat2021. Results: 50 patients with upper pole access were included (64%, 32 with single access and 36%, 18 with multiple accesses). The mean stone size was 23.88 ± 9.99, mean HU was 1093 ± 232.83, and the mean operative duration was 67.92 ± 34.62. Stone clearance rate was 98.82%, with all procedures performed tubeless.The mean haemoglobin drop was 0.75 ± 0.42 gm/dl with 2 (4%) patients needing a blood transfusion. The overall complication rate was 22% with only 1 Clavien Dindo III complication (1 pleural injury and hydrothorax needing USS guided aspiration) and others being Clavien Dindo I/II complications. Conclusion: Supine PCNL is a feasible and safe approach for upper pole access. While the procedure can be done tubeless, these procedures must be done in experienced endourology units.