Hungarian Society of Urology

Supine position tubeless percutaneous nephrolithotomy

DOI: 10.22591/magyurol.2021.2.raganm.59

Ragán Márton dr.1, Dombóvári Péter dr.2, Beöthe Tamás dr.2,
Daniel Swallow dr.3, Kertész László dr.2, Máté Kinga dr.1, Buzogány István dr.2
1Szt. Lázár Megyei Kórház, Urológiai Osztály, Salgótarján (osztályvezető: Buzogány István dr.)
2Péterfy Kórház-Rendelőintézet és Manninger Jenő Országos Traumatológiai Intézet,Budapest (osztályvezető: Buzogány István dr.)
3Broomfield Hospital, Urology Centre, Chelmsford, Essex, UK


Introduction: The PCNL (percutaneous nephrolithotomy) can be performed in prone (Pron) and supine (Sup) position. In the recent years, it became more common, to perform this procedure without a kidney drain (tubeless), and leaving the JJ ureteric stent in situ only.
Material and methods: The authors introduce the method of a supine, tubeless PCNL. They conducted a retrospective analysis of the supine, tubeless PCNL cases performed in Broomfield Hospital (UK), Szent-Lazar Hospital (Salgotarjan) and Urology Department of Peterfy Hospital (Budapest) between March of 2019 and July of 2020. The PCNL was the first choice for the kidney stones > 2 cm of size, for the lower calyx stones and the cystine stones, and also for the stones of >15 mm
in size with density of >1500 HU (Hounsfield Unit).
They considered the procedure successful, when the residual stone fragments were <4 mm in size on the follow up imagings.
The kidney stones of size of <10-15 mm were successfully treated by flexible ureteroscopy, and bigger stones were treated with the supine and tubeless PCNL, which is also suitable for staghorn kidney stones, filling out the all collecting system of the kidney.
Results: There were 58 procedures performed in the 3 departments (Broomfield 25/Salgotarjan 26/Péterfy 6). The average age of the patients who were operated in our Urology Departments in Salgotarjan or Budapest was 54 years (the youngest was 38 years old and the oldest was 80 years old), comparing to 66 years of average age in the UK (25–88) patients` group. CT scan was carried out prior to all procedures.
There was no difference in comparison of the results provided and published by David Curry, MD (2017) lead group and our results, in a view of the percentage of clearance, blood transfusions, type of drainage, length of stay in hospital and the ratio of significant complications (Clavien >3).
Conclusion: The supine PCNL technique is safe to perform with an appropriate training and adequate team, and also more effective from clearance point of view, when combined with the FURS as ECIRS procedure (endoscopic combined intra-renal surgery).
The position of the patient and the use of a JJ stent at the end of the procedure (tubeless technique), instead of a transrenal drainage (nephrostomy), does not influence either the success or the ratio of significant complications of this procedure.
This procedure significantly decreases anesthetic risks and burden of the operation for the patients. The supine PCNL requires a shorter operating time comparing to the prone one, and is also faster, due to the easier positioning of the patient. The tubeless technique is definitely more favorable considering the length of stay at hospital, and usually the patient can be discharged on the 1st postoperative day, amid lack of nephrostomy.
The disadvantage is the necessity of another minor intervention, rigid or flexible cystoscopy, to remove the stent in 1-2 weeks after the PCNL.


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