World Journal of Urology

, Volume 31, Issue 6, pp 1575–1580 | Cite as

Lower pole stones: prone PCNL versus supine PCNL in the International Cooperation in Endourology (ICE) group experience

  • Francesco Sanguedolce
  • Alberto Breda
  • Felix Millan
  • Marianne Brehmer
  • Thomas Knoll
  • Evangelos Liatsikos
  • Palle Osther
  • Olivier Traxer
  • Cesare Scoffone
Original Article
First Online:
Received:
Accepted:

Abstract

Purpose

To assess efficacy and safety of prone- and supine percutaneous nephrolithotomy (PCNL) for the treatment of lower pole kidney stones.

Methods

Data from patients affected by lower pole kidney stones and treated with PCNL between December 2005 and August 2010 were collected retrospectively by seven referral centres. Variables analysed included patient demographics, clinical and surgical characteristics, stone-free rates (SFR) and complications. Statistical analysis was conducted to compare the differences for SFRs and complication rates between prone- and supine PCNL.

Results

One hundred seventeen patients underwent PCNL (mean stone size: 19.5 mm) for stones harboured only in the lower renal pole (single stone: 53.6 %; multiple stones: 46.4 %). A higher proportion of patients with ASA score ≥ 3 and harbouring multiple lower pole stones were treated with supine PCNL (5.8 vs. 23.1 %; p = 0.0001, and 25 vs. 81.5 %; p = 0.0001, respectively, for prone- and supine PCNL). One-month SFR was 88.9 %; an auxiliary procedure was needed in 6 patients; the 3-month SFR was 90.2 %. There were 9 post-operative major complications (7.7 %). No differences were observed in terms of 1- and 3-month SFRs (90.4 vs. 87.7 %; p = 0.64; 92.3 vs. 89.2 %; p = 0.4) and complication rates (7.6 vs. 7.7 %; p = 0.83) when comparing prone- versus supine PCNL, respectively.

Conclusions

The results confirm the high success rate and relatively low morbidity of modern PCNL for lower pole stones, regardless the position used. Supine PCNL was more frequently offered in case of patients at higher ASA score and in case of multiple lower pole stones.

Keywords

Percutaneous nephrolithotripsy Prone- and supine PCNL Lower pole kidney stones Urolithiasis 
This is a preview of subscription content, log in to check access.

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Lingeman JE, Siegel YI, Steele B, Nyhuis AW, Woods JR (1994) Management of lower pole nephrolithiasis: a critical analysis. J Urol 151(3):663–667PubMedGoogle Scholar
  2. 2.
    Obek C, Onal B, Kantay K, Kalkan M, Yalcin V, Oner A, Solok V, Tansu N (2001) The efficacy of extracorporeal shock wave lithotripsy for isolated lower pole calculi compared with isolated middle and upper caliceal calculi. J Urol 166(6):2081–2084 discussion 2085PubMedCrossRefGoogle Scholar
  3. 3.
    Hussain M, Acher P, Penev B, Cynk M (2011) Redefining the limits of flexible ureterorenoscopy. J Endourol 25(1):45–49. doi: 10.1089/end.2010.0236 PubMedCrossRefGoogle Scholar
  4. 4.
    Bozkurt OF, Resorlu B, Yildiz Y, Can CE, Unsal A (2011) Retrograde intrarenal surgery versus percutaneous nephrolithotomy in the management of lower-pole renal stones with a diameter of 15 to 20 mm. J Endourol 25(7):1131–1135. doi: 10.1089/end.2010.0737 PubMedCrossRefGoogle Scholar
  5. 5.
    Lee WJ, Smith AD, Cubelli V, Badlani GH, Lewin B, Vernace F, Cantos E (1987) Complications of percutaneous nephrolithotomy. AJR Am J Roentgenol 148(1):177–180PubMedCrossRefGoogle Scholar
  6. 6.
    Jackman SV, Docimo SG, Cadeddu JA, Bishoff JT, Kavoussi LR, Jarrett TW (1998) The “mini-perc” technique: a less invasive alternative to percutaneous nephrolithotomy. World J Urol 16(6):371–374PubMedCrossRefGoogle Scholar
  7. 7.
    Giusti G, Piccinelli A, Taverna G, Benetti A, Pasini L, Corinti M, Teppa A, Zandegiacomo de Zorzi S, Graziotti P (2007) Miniperc? No, thank you! Eur Urol 51(3):810–814. doi: 10.1016/j.eururo.2006.07.047 discussion 815PubMedCrossRefGoogle Scholar
  8. 8.
    Knoll T, Wezel F, Michel MS, Honeck P, Wendt-Nordahl G (2010) Do patients benefit from miniaturized tubeless percutaneous nephrolithotomy? A comparative prospective study. J Endourol 24(7):1075–1079. doi: 10.1089/end.2010.0111 PubMedCrossRefGoogle Scholar
  9. 9.
    Ibarluzea G, Scoffone CM, Cracco CM, Poggio M, Porpiglia F, Terrone C, Astobieta A, Camargo I, Gamarra M, Tempia A, Valdivia Uria JG, Scarpa RM (2007) Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access. BJU Int 100(1):233–236. doi: 10.1111/j.1464-410X.2007.06960.x PubMedCrossRefGoogle Scholar
  10. 10.
    Scoffone CM, Cracco CM, Cossu M, Grande S, Poggio M, Scarpa RM (2008) Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: a new standard for percutaneous nephrolithotomy? Eur Urol 54(6):1393–1403. doi: 10.1016/j.eururo.2008.07.073 PubMedCrossRefGoogle Scholar
  11. 11.
    Turk C, Knoll T, Petrik A, Sarica K, Straub M, Traxer O; Members of the European Association of Urology (EAU) Guidelines Office (2010) Guidelines on urolithiasis. In: EAU guidelines, edition presented at the 25th EAU annual congress, Barcelona, 2010; ISBN 978-90-79754-70-0Google Scholar
  12. 12.
    Raman JD, Bagrodia A, Gupta A, Bensalah K, Cadeddu JA, Lotan Y, Pearle MS (2009) Natural history of residual fragments following percutaneous nephrostolithotomy. J Urol 181(3):1163–1168. doi: 10.1016/j.juro.2008.10.162 PubMedCrossRefGoogle Scholar
  13. 13.
    Türk C, Knoll T, Petrik K, Sarica M, Straub C, Seitz (members of the European Association of Urology (EAU) Guidelines Office) (2012) Guidelines on urolithiasis. In: EAU guidelines, edition presented at the 27th EAU annual congress, Paris, 2012Google Scholar
  14. 14.
    Sampaio FJ, Aragao AH (1994) Limitations of extracorporeal shockwave lithotripsy for lower caliceal stones: anatomic insight. J Endourol 8(4):241–247PubMedCrossRefGoogle Scholar
  15. 15.
    Elbahnasy AM, Shalhav AL, Hoenig DM, Elashry OM, Smith DS, McDougall EM, Clayman RV (1998) Lower caliceal stone clearance after shock wave lithotripsy or ureteroscopy: the impact of lower pole radiographic anatomy. J Urol 159(3):676–682PubMedCrossRefGoogle Scholar
  16. 16.
    Tefekli A, Ali Karadag M, Tepeler K, Sari E, Berberoglu Y, Baykal M, Sarilar O, Muslumanoglu AY (2008) Classification of percutaneous nephrolithotomy complications using the modified Clavien grading system: looking for a standard. Eur Urol 53(1):184–190. doi: 10.1016/j.eururo.2007.06.049 PubMedCrossRefGoogle Scholar
  17. 17.
    Michel MS, Trojan L, Rassweiler JJ (2007) Complications in percutaneous nephrolithotomy. Eur Urol 51(4):899–906. doi: 10.1016/j.eururo.2006.10.020 discussion 906PubMedCrossRefGoogle Scholar
  18. 18.
    de la Rosette J, Assimos D, Desai M, Gutierrez J, Lingeman J, Scarpa R, Tefekli A (2011) The Clinical Research Office of the endourological society percutaneous nephrolithotomy global study: indications, complications, and outcomes in 5803 patients. J Endourol 25(1):11–17. doi: 10.1089/end.2010.0424 PubMedCrossRefGoogle Scholar
  19. 19.
    Nagele U, Schilling D, Anastasiadis AG, Corvin S, Seibold J, Kuczyk M, Stenzl A, Sievert KD (2006) Closing the tract of mini-percutaneous nephrolithotomy with gelatine matrix hemostatic sealant can replace nephrostomy tube placement. Urology 68(3):489–493. doi: 10.1016/j.urology.2006.03.081 discussion 493-484PubMedCrossRefGoogle Scholar
  20. 20.
    Lahme S, Bichler KH, Strohmaier WL, Gotz T (2001) Minimally invasive PCNL in patients with renal pelvic and calyceal stones. Eur Urol 40(6):619–624PubMedCrossRefGoogle Scholar
  21. 21.
    Nagele U, Horstmann M, Sievert KD, Kuczyk MA, Walcher U, Hennenlotter J, Stenzl A, Anastasiadis AG (2007) A newly designed amplatz sheath decreases intrapelvic irrigation pressure during mini-percutaneous nephrolitholapaxy: an in vitro pressure-measurement and microscopic study. J Endourol 21(9):1113–1116. doi: 10.1089/end.2006.0230 PubMedCrossRefGoogle Scholar
  22. 22.
    Marguet CG, Springhart WP, Tan YH, Patel A, Undre S, Albala DM, Preminger GM (2005) Simultaneous combined use of flexible ureteroscopy and percutaneous nephrolithotomy to reduce the number of access tracts in the management of complex renal calculi. BJU Int 96(7):1097–1100. doi: 10.1111/j.1464-410X.2005.05808.x PubMedCrossRefGoogle Scholar
  23. 23.
    De Sio M, Autorino R, Quarto G, Calabro F, Damiano R, Giugliano F, Mordente S, D’Armiento M (2008) Modified supine versus prone position in percutaneous nephrolithotomy for renal stones treatable with a single percutaneous access: a prospective randomized trial. Eur Urol 54(1):196–202. doi: 10.1016/j.eururo.2008.01.067 PubMedCrossRefGoogle Scholar
  24. 24.
    Falahatkar S, Moghaddam AA, Salehi M, Nikpour S, Esmaili F, Khaki N (2008) Complete supine percutaneous nephrolithotripsy comparison with the prone standard technique. J Endourol 22(11):2513–2517. doi: 10.1089/end.2008.0463 PubMedCrossRefGoogle Scholar
  25. 25.
    Manohar T, Jain P, Desai M (2007) Supine percutaneous nephrolithotomy: effective approach to high-risk and morbidly obese patients. J Endourol 21(1):44–49. doi: 10.1089/end.2006.0212 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Francesco Sanguedolce
    • 1
  • Alberto Breda
    • 1
  • Felix Millan
    • 1
  • Marianne Brehmer
    • 2
  • Thomas Knoll
    • 3
  • Evangelos Liatsikos
    • 4
  • Palle Osther
    • 5
  • Olivier Traxer
    • 6
  • Cesare Scoffone
    • 7
  1. 1.Fundació Puigvert, Department of UrologyAutonomous University of BarcelonaBarcelonaSpain
  2. 2.Department of UrologyKarolinska University HospitalStockholmSweden
  3. 3.Department of Urology, Klinikum SindelfingenUniversity of TübingenTübingenGermany
  4. 4.Department of UrologyPatras UniversityPatrasGreece
  5. 5.Department of Urology, Frederica HospitalUniversity of Southern DenmarkFredericiaDenmark
  6. 6.Department of Urology, Tenon Hospital6th University of ParisParisFrance
  7. 7.Department of UrologyCottolengo HospitalTurinItaly

Personalised recommendations