PILOT EXPERIENCE OF PERCUTANEOUS NEPHROLITHOTRIPSY IN DORSAL POSITIONING OF THE PATIENT


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Abstract

Percutaneous nephrolithotripsy (PNLT) is widely used in surgical treatment of nephrolithiasis. The patient’s body position in this operation is, as a rule, prone. However, this position is often uncomfortable or even impossible for patients with obesity, bone diseases and deformations which sometimes occur in pulmonary, cardiovascular and other diseases. The aim of our study was to see how dorsal positioning of the patient during PNLT influences the results of this surgery. A total of 109 patients after PNLT for concrements of the upper urinary tract entered the study. They were divided into two groups: operated in the dorsal position (n=46, 42.2% - the study group) and operated in the standard prone position (n=63, 57.8% - the control group). The patients were matched by gender, age, size and location of the concrements, surgical procedure. Residual concrements were detected in 9(19.5%) patients of the study group, 7 of them were reoperated (PNLT, ureterolithotripsy, extracorporeal lithotripsy) while in the control group residual concrements were in 10 (14.9%) patients, 7 of them (10.4%) were reoperated. Thus, complete concrements evacuation from the upper urinary tract was achieved in 80.5 and 85.1%, respectively. Mean duration of the operation was 66.4 and 72.6 min, respectively; mean bed occupancy was 9.3 and 9.1 day, respectively. Complications in both groups consisted for the most part of postoperative hematuria and exacerbation of pyelonephritis. No injuries of the adjacent organs were registered. Thus, PNLT in dorsal position is an effective and safe treatment of nephrolithiasis, especially in patients with obesity, bone lesions and severe concomitant diseases.

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