Surgical Outcome of Modified Supine versus Prone Percutaneous in Patient Undergoing PCNL

Farhan  Khan; Ravi Kiran  Gautam; Zulfikar  Ahmed; Usman  Qamar; Mehran Khan  Lashari; Shafique Ur Rehman

doi:10.29054/apmc/2023.1209

Farhan Khan Assistant Professor, Department of Urology, Bilawal Medical College, LUMHS, Jamshoro Pakistan
Ravi Kiran Gautam Urologist, Department of Urology, Sahid Dharma bhakta National Transplant Center, Bhaktapur, Nepal
Zulfikar Ahmed Assistant Professor, Department of Urology & Renal Transplant, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat Pakistan
Usman Qamar Assistant Professor, Department of Urology, Sindh Institute of Urology and Transplantation, Karachi Pakistan
Mehran Khan Lashari Consultant Urologist, Syed Abdullah Shah Institute of Medical Sciences, Sehwan Sharif Pakistan
Shafique Ur Rehman Professor, Department of Urology, Bilawal Medical College, LUMHS, Jamshoro Pakistan

DOI: https://doi.org/10.29054/apmc/2023.1209

Keywords: Renal calculus, PCNL, Prone position, Supine position, Treatment outcomes

Abstract

Background: Percutaneous nephrolithotomy (PCNL) is considered the preferred treatment option for kidney stones > 2 CM in size. The conventional prone position for percutaneous nephrolithotomy (PCNL) is commonly preferred by urologists for several reasons. The modified supine position, which involves a tilted supine position combined with lithotomy, offers an additional advantage by enabling simultaneous retrograde access to the upper urinary tract. Objective: To compare the surgical outcome of modified supine versus prone percutaneous in patients undergoing percutaneous nephrolithotomy (PCNL) at a tertiary care hospital. Study Design: Randomized Control Trial. Settings: This study was conducted in inpatients in Section of Urology, Department of Surgery, SIUT Hospital Karachi Pakistan. Duration: Six months from November 2021 to April 2021. Methods: Patients diagnosed with renal calculi requiring PCNL as the treatment modality visited in section of urology, Sindh institute of urology and transplantation (SIUT) Karachi were included. The total of 186 Patients was randomly divided into two equal groups A (modified supine) and B (prone percutaneous) by envelop method. The primary outcome measures assessed were the duration of surgery and the stone clearance rate. The duration of surgery was defined as the time from the start of the procedure to its completion. All the information was collected through study proforma. Results: In this study 186 patients were divided randomly by envelop method into two equal groups A (modified supine) and B (prone percutaneous) to compare the surgical outcome of modified supine versus prone percutaneous. Mean age in modified supine group was 35.15±10.90 years and in prone percutaneous was 38.49±10.44 years. Duration of surgery was 45.34±6.31 and 72.60±9.83 minutes in modified supine versus prone percutaneous group respectively (P=0.001). The stone clearance rate was found to be 72 (77.42%) in modified supine group versus 76 (81.72%) was noted in prone percutaneous group and p value found to be non-significant (p= 0.467). Clearance rate of the stone was statistically insignificant according to age, gender and location of stone (p= >0.05). Conclusion: It is to be concluded that modified supine PCNL demonstrates less operative time compared to prone PCNL, the stone clearance rate remains similar. The choice of position should be made based on individual patient characteristics, surgeon experience, and institutional resources.