Mp04-08 Targeting Posterior Calyx in Supine vs Prone PCNL Under Regional Anesthesia With Fluoroscopic Screening Time: Safety and Effectiveness Comparison of a Single Centre

You have accessJournal of UrologyStone Disease: Surgical Therapy (including ESWL) I (MP04)1 May 2024MP04-08 TARGETING POSTERIOR CALYX IN SUPINE VS PRONE PCNL UNDER REGIONAL ANESTHESIA WITH FLUOROSCOPIC SCREENING TIME: SAFETY AND EFFECTIVENESS COMPARISON OF A SINGLE CENTRE Jaisukh Kalathia, Kaushal Patel, Bharti Talreja, Kuldeep Aggarwal, Santosh Agrawal, Giriraj Vala, Arvind Valiya, Ayush Khetarpal, Prathan Joshi, and Devang Undaviya Jaisukh KalathiaJaisukh Kalathia , Kaushal PatelKaushal Patel , Bharti TalrejaBharti Talreja , Kuldeep AggarwalKuldeep Aggarwal , Santosh AgrawalSantosh Agrawal , Giriraj ValaGiriraj Vala , Arvind ValiyaArvind Valiya , Ayush KhetarpalAyush Khetarpal , Prathan JoshiPrathan Joshi , and Devang UndaviyaDevang Undaviya View All Author Informationhttps://doi.org/10.1097/01.JU.0001008708.00982.a9.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Percutaneous nephrolithotomy (PCNL) via posterior calyx is more facile as compared to anterior calyx. While establishing perfect posterior calyx access is the gateway to a successful PCNL in both supine and prone positions, we prospectively analyzed feasibility of targeting posterior calyx in prone vs supine position and fluoroscopic screening time (FST) for radiation exposure. METHODS: Between January 2022 to June August 2023, 478 patients underwent PCNL. Out of these, 240 patients were equally randomized into Group A- Supine and Group B- Prone respectively. Both Bull's eye and triangulation technique were used for puncturing to access the posterior calyx under fluoroscopy guidance with contrast pyelogram. Pulsed and continuous mode used in fluoroscopy were recorded for FST. Post-operative radiological investigations (ultrasonography/CT scans) were conducted to confirm the accuracy of the punctures. Patient's demographics, post-operative hemodynamics, analgesic pain scores using self-administered Visual Analogue Scale (VAS), stone clearance, operative time and length of hospitalization were prospectively analyzed. RESULTS: Group-A punctures were made in Flank oblique supine modified lithotomy (FOSML) positions. USG/CT confirmed posterior calyx was perfectly accessible in Group-A patients was 112 (93.93%) and in Group-B was achievable only in 82 (68.33%). Additional secondary tracts were made for secondary stones. FST were 45±12 seconds and 75 45±15 seconds in Group-A and Group-B respectively. Perioperative hemodynamic stability in regional anesthesia was maintained in both groups with only 4 (3.33%) requiring inotropic support in Group-B patients. Stone free rate was achieved in 90% of patients under fluoroscopy in both the groups with only 18 (7.5%) patients having residual calculi requiring ancillary procedures. Pain scores was bearable with average reporting VAS 2 2-3 on Day 1 and Day 2. Average length of hospitalization was 2.5 days with no major perioperative complications. CONCLUSIONS: Targeting posterior calyx in PCNL is quicker, safer, effective and feasible in supine position than prone position with reduced radiation exposure. Source of Funding: Nil © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e37 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Jaisukh Kalathia More articles by this author Kaushal Patel More articles by this author Bharti Talreja More articles by this author Kuldeep Aggarwal More articles by this author Santosh Agrawal More articles by this author Giriraj Vala More articles by this author Arvind Valiya More articles by this author Ayush Khetarpal More articles by this author Prathan Joshi More articles by this author Devang Undaviya More articles by this author Expand All Advertisement PDF downloadLoading ...