A.I. Sagalevich, S.A. Vozianov, B.V. Juran, V.V. Kogut

Supine percutaneous nephrolithotomy – what a singularity?

Prone position with combination endotracheal anesthesia - standard percutaneous nephrolithotomy (PNL). However, among patients at high anesthetic risk, this approach may lead to hemodynamic and respiratory complications. Between 2014-2016 y. 245 performed mini-PNL by standard methods, where 228 (93,1%) cases, the operation was performed in a prone position on the patient (group 1) and 17 (6,9%) cases on the supine position (group 2), which served as a various comorbidities with cardiovascular or respiratory systems. Mini PNL conducted under epidural regional anesthesia in 224 (91,4%) cases, and 21 (8,6%) under epidural anesthesia. We did not observe significant differences in the study groups for the studied criteria such as bleeding (6,9%), injury to adjacent organs (0%) and kidney perforation (0,8%). Differences were noted in the state of «stone free» - up to 92% in both groups. When the mini-PCNL in the supine patient, noted a decrease in the time duration of the operation (no need for a revolution of the patient), and it is possible to carry out simultaneous endoscopic procedures (transurethral and percutaneous). Thus, the supine position of the patient, during the execution of PNL, in conjunction with the regional (epidural) anesthesia is a relatively safe procedure. Hemodynamic and respiratory parameters are easily controlled during surgery, which has a number of benefits for patients, urologists and anesthesiologists. And the complications and treatment results are comparable with current as well as in the performance of PNL in the prone position of the patient.