Endoscopic-guided percutaneous nephrolithotomy (EPSL) with prone split-leg position for complex kidney stone: A case report

INTRODUCTION: The optimal patient positioning for percutaneous nephrolithotomy (PCNL) based on the complexity of stone burden is not yet defined in the literature This report elaborated left complex kidney stones case underwent endoscopic-guided PCNL with a prone split-leg position (ePSL). PRESENTATION OF CASE: : Forty-three years old women were referred with a history of failed left open kidney surgery because of frozen kidney. A renal biopsy examination confirmed xanthogranulomatous tissue. Standard prone PCNL was performed. There were so many debris in pelviocalyceal system, so we used ultrasound guidance to puncture instead of fluoroscopy. There was residual stone in superior calyx that nephroscope couldn’t reach. ePSL method was used in the second procedure. The stone was fragmented with pneumatic lithotripter. Evaluation using C-arm and nephroscope illustrated no residual stones, infundibulum laceration, and active bleeding. DISCUSSION: This technique's main objectives are to remove urinary tract stones along the whole tract with a one-step and one-access approach with optimal utilization of full array endourologic equipment. The prone split-leg position was chosen for multiple reasons such as operator preference, the familiarity of a specific position, and inability to perform direct puncture in the upper pole. The main limitation is no long-term follow-up for patients to see the effectiveness and safety of this technique. CONCLUSION: To conclude, ePSL with a prone split-leg position is a safe procedure with a relatively low rate of complications and can be used for complex kidney stone.