The Barts 'flank-free' modified supine position for percutaneous nephrolithotomy.

Abstract:

BACKGROUND:The last decade has seen the emergence of a variety of supine positions for carrying out percutaneous nephrolithotomy (PCNL). These positions all differ with regard to ease of puncture under image guidance, operative field availability, ability to make and dilate multiple tracts and ease of combining retrograde intrarenal surgery (RIRS). As all of these positions have their limitations regarding the important parameters mentioned above, there is a need for a supine position which addresses some of the difficulties. METHODS:We describe and illustrate our flank-free modified supine position, which we believe addresses a number of the issues. RESULTS:Our position allows easy percutaneous access under fluoroscopy (torso only tilted to around 15°), space for placing (flank free of support) and dilating multiple tracts (kidney lies in a fairly neutral position and hence less mobile), a fairly horizontal tract allowing low intrarenal pressures and easy washout of fragments as well as allowing RIRS in a position of relative familiarity. The lesser torso rotation compared with the Valdivia, Galdakao modified and the Barts modified Valdivia positions also means it is more comfortable for patients. CONCLUSIONS:Our results are encouraging and easily comparable with published series on prone position, Valdivia, complete supine and the Barts modified Valdivia positions. We would like to highlight the Barts 'flank-free' modified supine position as one of the standard positions for carrying out supine PCNL.

journal_name

Urol Int

journal_title

Urologia internationalis

authors

Bach C,Goyal A,Kumar P,Kachrilas S,Papatsoris AG,Buchholz N,Masood J

doi

10.1159/000341430

subject

Has Abstract

pub_date

2012-01-01 00:00:00

pages

365-8

issue

3

eissn

0042-1138

issn

1423-0399

pii

000341430

journal_volume

89

pub_type

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