The Effectiveness and Safety of Supine Percutaneous Nephrolithotomy in Single-Center Tertiary Hospital

Abstract

ABSTRACT Introduction : Percutaneous nephrolithotomy (PCNL) is currently recommended for patients with kidney stones larger than 20 mm. PCNL was firstly introduced in supine position in 1986. It demonstrated advantages in terms of ergonomics and shown to be less risky compared to prone position. However, there is still lack of evidence for the effectiveness nor safety of supine PCNL in Indonesia. Objective: To analyze the effectiveness and safety of supine PCNL in single centre tertiary hospital. Materials and Methods : 506 patients undergone supine PCNL from January 2017 to December 2021 in Dr. Kariadi general hospital were invited as sample. The retrospective data was collected from the electronic medical record system and then tabulated and analyzed using SPSS system. Results : Out of 506 samples, the mean age was 53.19±11.82 years old with the youngest being 1 year old and the oldest being 82 years old. The stone locations were calyceal; 221 patients (43.68%), pelvis; 155 patients (30.63%), and multiple; 130 patients (25.69%). The stone size was divided into two category: >20 mm; 372 patients (73.52%) and <20 mm; 134 patients (26.48%). The mean operation time was 84±41.24 minutes with the shortest being 30 minutes and the longest being 239 minutes. Supine PCNL was performed with single puncture in 495 patients (97.83%) and with multiple punctures in 11 patients (2.17%). The total stone free rate was 95.65%. 22 patients undergone another stone removal procedures after receiving supine PCNL (2nd PCNL; 6 (1.18%), ESWL; 16 (3.16%). The mean post-operative length of hospital stay was 4.1±1.48 days with the shortest being 1 day and the longest being 8 days. 28 minor complications such as infections and blood loss were recorded with only 1 case of colon perforation which is considered to be major complication. Conclusions : Supine PCNL in our centre is shown to have high stone free rate, short hospital stay, and low post-operative complications. These outcomes are the key component of this minimally- invasive procedure. Thus, mark the effectiveness and safety of supine PCNL in our centre.