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Factors Predicting Outcomes of Supine Percutaneous Nephrolithotomy: Large Single-Centre Experience

Objective: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large renal calculi. The prone position has been considered the preferred position to obtain renal access. However, the supine position has recently gained popularity, which confers several potential advantages. The curren...

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Autores principales: Abu-Ghanem, Yasmin, Forster, Luke, Khetrapal, Pramit, Ellis, Gidon, Singh, Paras, Srinivasan, Rohit, Kucheria, Rajesh, Goyal, Anuj, Allen, Darrell, Goode, Antony, Yu, Dominic, Ajayi, Leye
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9784354/
https://www.ncbi.nlm.nih.gov/pubmed/36556177
http://dx.doi.org/10.3390/jpm12121956
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author Abu-Ghanem, Yasmin
Forster, Luke
Khetrapal, Pramit
Ellis, Gidon
Singh, Paras
Srinivasan, Rohit
Kucheria, Rajesh
Goyal, Anuj
Allen, Darrell
Goode, Antony
Yu, Dominic
Ajayi, Leye
author_facet Abu-Ghanem, Yasmin
Forster, Luke
Khetrapal, Pramit
Ellis, Gidon
Singh, Paras
Srinivasan, Rohit
Kucheria, Rajesh
Goyal, Anuj
Allen, Darrell
Goode, Antony
Yu, Dominic
Ajayi, Leye
author_sort Abu-Ghanem, Yasmin
collection PubMed
description Objective: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large renal calculi. The prone position has been considered the preferred position to obtain renal access. However, the supine position has recently gained popularity, which confers several potential advantages. The current study analyses the prognostic factors for successful supine PCNL procedures in a larger tertiary centre. Subjects: Prospective data were collected from all patients undergoing PCNL in the Galdako modified Valdivia position at our institution between February-2007 and September-2020. Surgical outcomes variables collected included: the rate of Endoscopic-combined intra-renal surgery (ECIRS), operative times, surgical effectiveness (no residuals <2 mm stone fragments) and complications. Results: A total of 592 patients underwent PCNL with a median age of 56 years (IQR: 42–67). The median stone size was 17 mm (IQR: 13–23). Of those, 79% of patients had an effective procedure. Stone size (p < 0.001), location (p < 0.001) and Guys-Stone Score (GSS) (p < 0.001) were associated with effectiveness. A Percutaneous nephrostomy tube was sited at the completion of the procedure in 97.3% of patients and a simultaneous double-J stent in 45.3%. Stent insertion was associated with larger stones (p < 0.001), the performance of ECIRS (p < 0.001) and higher GSS (p < 0.001). The overall complication rate was 21.7%. The main type of complication was an infection in 26.2 of the cases followed by the need for repeated nephrostogram in 12.7%. Conclusions: We demonstrate that PCNL in a high-volume centre is safe and efficacious in the Galdalko modified Valdivia position. Patients with smaller stones in the renal pelvis and a low GSS have the highest chance of a successful procedure.
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spelling pubmed-97843542022-12-24 Factors Predicting Outcomes of Supine Percutaneous Nephrolithotomy: Large Single-Centre Experience Abu-Ghanem, Yasmin Forster, Luke Khetrapal, Pramit Ellis, Gidon Singh, Paras Srinivasan, Rohit Kucheria, Rajesh Goyal, Anuj Allen, Darrell Goode, Antony Yu, Dominic Ajayi, Leye J Pers Med Article Objective: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large renal calculi. The prone position has been considered the preferred position to obtain renal access. However, the supine position has recently gained popularity, which confers several potential advantages. The current study analyses the prognostic factors for successful supine PCNL procedures in a larger tertiary centre. Subjects: Prospective data were collected from all patients undergoing PCNL in the Galdako modified Valdivia position at our institution between February-2007 and September-2020. Surgical outcomes variables collected included: the rate of Endoscopic-combined intra-renal surgery (ECIRS), operative times, surgical effectiveness (no residuals <2 mm stone fragments) and complications. Results: A total of 592 patients underwent PCNL with a median age of 56 years (IQR: 42–67). The median stone size was 17 mm (IQR: 13–23). Of those, 79% of patients had an effective procedure. Stone size (p < 0.001), location (p < 0.001) and Guys-Stone Score (GSS) (p < 0.001) were associated with effectiveness. A Percutaneous nephrostomy tube was sited at the completion of the procedure in 97.3% of patients and a simultaneous double-J stent in 45.3%. Stent insertion was associated with larger stones (p < 0.001), the performance of ECIRS (p < 0.001) and higher GSS (p < 0.001). The overall complication rate was 21.7%. The main type of complication was an infection in 26.2 of the cases followed by the need for repeated nephrostogram in 12.7%. Conclusions: We demonstrate that PCNL in a high-volume centre is safe and efficacious in the Galdalko modified Valdivia position. Patients with smaller stones in the renal pelvis and a low GSS have the highest chance of a successful procedure. MDPI 2022-11-25 /pmc/articles/PMC9784354/ /pubmed/36556177 http://dx.doi.org/10.3390/jpm12121956 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Abu-Ghanem, Yasmin
Forster, Luke
Khetrapal, Pramit
Ellis, Gidon
Singh, Paras
Srinivasan, Rohit
Kucheria, Rajesh
Goyal, Anuj
Allen, Darrell
Goode, Antony
Yu, Dominic
Ajayi, Leye
Factors Predicting Outcomes of Supine Percutaneous Nephrolithotomy: Large Single-Centre Experience
title Factors Predicting Outcomes of Supine Percutaneous Nephrolithotomy: Large Single-Centre Experience
title_full Factors Predicting Outcomes of Supine Percutaneous Nephrolithotomy: Large Single-Centre Experience
title_fullStr Factors Predicting Outcomes of Supine Percutaneous Nephrolithotomy: Large Single-Centre Experience
title_full_unstemmed Factors Predicting Outcomes of Supine Percutaneous Nephrolithotomy: Large Single-Centre Experience
title_short Factors Predicting Outcomes of Supine Percutaneous Nephrolithotomy: Large Single-Centre Experience
title_sort factors predicting outcomes of supine percutaneous nephrolithotomy: large single-centre experience
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9784354/
https://www.ncbi.nlm.nih.gov/pubmed/36556177
http://dx.doi.org/10.3390/jpm12121956
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