Modified supine versus prone percutaneous nephrolithotomy for renal calculi.

Abstract

Objective: To find out the best position in the practice of PCNL. Study Design: Randomized Controlled Trial. Setting: Department of Urology, AFIU, Rawalpindi. Period: August 2020 to January 2021. Methods: A total of 164 adult (20-70 years) patients of either gender undergoing percutaneous nephrolithotomy for single renal calculus with size >20 mm through single puncture access were included. Patients with staghorn stone, recurrent stone, PUJO, pyonephrosis and bleeding disorder were excluded. In group A patients, modified supine PCNL was done while in group B patients, prone PCNL was done. Operative time was noted by the researcher himself with the help of stopwatch. All patients were followed by researcher himself for assessment of complications and drop in hemoglobin levels. Postoperatively patients were evaluated for stone free rate. Hospital stay was noted. Results: In my study, stone free rate after supine PCNL was found in 66 (80.49%) patients and after prone PCNL in 45 (54.88%) patients (p-value = 0.0001). Complications rate after modified supine PCNL was found to be 8.54% patients and after prone PCNL was 20.73% (p-value = 0.027). In my study, mean operative time in supine PCNL was 86.12 ± 9.33 minutes and in prone PCNL was 110.80 ± 13.35 minutes. Mean hospital stay in supine PCNL was 1.77 ± 0.79 days and in prone PCNL was 2.49 ± 0.81 days. Mean drop in hemoglobin levels was 0.82 ± 0.24 g/dl vs 1.77 ± 0.24 g/dl respectively (p-value = 0.0001). Conclusion: This study concluded that mean operative time, hospital stay, drop in hemoglobin and complications are less while stone free rate is high after modified supine PCNL as compared to prone percutaneous nephrolithotomy.