Modified supine percutaneous nephrolithotomy with combined fluoroscopy and ultrasound-guided renal puncture: Initial single-surgeon experience at a UK teaching hospital

Abstract

Objective:

The purpose of this article is to report the outcomes of our initial experience of performing percutaneous nephrolithotomy in the supine position using ultrasound guidance in addition to fluoroscopy for renal access.

Patients and methods:

The first 34 consecutive modified supine percutaneous nephrolithotomy cases performed by a single consultant urologist inserting their own percutaneous tracts using ultrasound-guidance and fluoroscopy were evaluated. Operative data was collected prospectively over a 10-month period including any complications. The stone-free rate was evaluated three months post-operatively with a plain film or non-contrast computed tomography of the kidneys, ureters and bladder.

Results:

Renal access was achieved in all 34 cases. Mean age was 57 years (19–82) with 14 males and 20 females. Mean stone size 37.2 mm (20–72 mm). Overall stone-free rate was 85.3% at a mean follow up of 11.2 months. There was one Clavien Grade I, and three Clavien Grade II complications of post-operative fever requiring treatment with intravenous antibiotics. No patients developed urosepsis, required blood transfusion or sustained any visceral injury. Median in-patient stay was one night (1–4).

Conclusion:

Modified supine percutaneous nephrolithotomy with combined fluoroscopy and ultrasound-guided renal access has a low incidence of complications allowing for short hospital stay.