الفهرس 
ENDOUROLOGIC ANATOMY OF THE KIDNEYOnly 14 pages are availabe for public view
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Abstract
C
urrently, percutaneous nephrolithotomy (PCNL) is the treatment of choice for large renal stones, staghorn calculi, stones resistant to fragmentation, or stones occurring in kidneys with an abnormal anatomy. The safety and efficacy of PCNL for the treatment of more complex stones and its use in more diverse patient populations, combined with the growing incidence of stone disease, likely explains the increasing use of PCNL for stone management as indicated by recent studies.
Traditionally, PCNL has been performed in the prone position, and the morbidity of the procedure has been well documented. Fourteen years ago, Valdivia Uria et al first described PCNL in the supine position, advocating several benefits for the patients, especially in those at higher anesthesiologic risk. Since then, several other investigators have reported their experience with this technique (Valdivia et al., 1998).
The necessity of position changes during the procedure is another disadvantage of the prone position technique, because replacement of a ureteral catheter is commonly required in the dorsal lithotomy position before turning the patient to the prone one.
Supine positioning for PCNL seems a very attractive option. Published series from different centres have shown that supine PCNL is safe and has several benefits not only for the patient but also has several technical advantages for the surgeon.
Today, many publications and editorial comments are appearing about the PCNL in supine position. These publications do nothing else but support the conclusions Valdivia has already pointed out 14 years ago. Mainly, that it is an easy to perform and reproducible technique that has a smaller risk of hands irradiation and a more comfortable working position for the urologist.
Results from our study shows that PCNL in supine position is an absolutely feasible, safe, and successful procedure with minimal complications, with results that are definitely comparable to the conventional prone position PCNL with the added benefit of shorter operative time and being more suitable for patients with compromised cardiopulmonary status, morbidly obese patients and those with stature deformities.
Evaluation the safety and efficacy of supine percutaneous nephrolithotomy was the aim of our prospective non randomized study conducted during the period from July 2011 till November 2012 in urology department, Ain shams and Misr University for science and technology hospitals. The study included 25 patients comprising 16 males and 9 females. Their mean age was 44.5 years (20-60), mean weight 69.3 kg (60-90), mean height 1.6 m (1.5-1.8) ,and mean BMI 24.1 kg/ m2 (20-27.7).The mean operative time was 80 minutes (70-100). We achieved a 84% stone-free rate. The mean hospital stay was 3.6 days (3-5).
In conclusion, a renewed interest in the supine position previously described by Valdivia Uria in 1998 had rose and this technique and its modifications are now gaining ground in centers of excellence. We approve that the supine position proved to be safe and effective in treatment of renal stones. We believe that supine position offers several advantages for the patient, the surgeon and the anaesthesiologist. However, it is difficult to change a standardized technique especially if efficient and with low complication rate. We believe that PCNL in the supine position in now an integral part of the contemporary endourologic practices. It completes the image beside the gold standard; the prone position. More clinical practice and subjective urological and radiological studies are needed to further clarify its position.