Advantages and disadvantages of percutaneous surgery of urolithiasis in the patient’s supine position

Abstract

BACKGROUND: Studying the clinical features of different surgical approaches in patients with urolithiasis with stones localized in the kidney and the upper third of the ureter is an important practical issue in modern urology. AIM: The aim of the study is a clinical evaluation of the results of percutaneous surgery for urolithiasis with the patient in the supine position. MATERIALS AND METHODS: The results of surgical treatment of 316 patients with urolithiasis with stones localized in the kidney (more than 10 mm) and the upper third of the ureter (more than 8 mm) are presented. All patients underwent percutaneous nephrolithotripsy in the supine position. RESULTS: Complete elimination of stones was achieved in 91.3% of patients with stones of the upper third of the ureter and 96.2% of patients with kidney stones. Clinical evaluation of the surgical results showed that the frequency of intraoperative complications of traumatic origin is about 10%, the most common complication being bleeding. At the same time, complications of grades IV and V according to the Clavien–Dindo classification were noted. Performing percutaneous nephrolithotripsy in the supine position reduces the time required to position the patient, allows for the combination of transurethral and percutaneous interventions, is more effective for patients with increased weight and concomitant diseases, and also provides a significant advantage in the need for ventilation and possible resuscitation. CONCLUSIONS: It is advisable to introduce a personalized approach to the choice of surgical access when performing invasive interventions on the upper urinary tract.