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Objective: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large renal calculi. The prone position has been considered the preferred position to obtain renal access. However, the supine position has recently gained popularity, which confers several potential advantages. The current study analyses the prognostic factors for successful supine PCNL procedures in a larger tertiary centre. Subjects: Prospective data were collected from all patients undergoing PCNL in the Galdako modified Valdivia position at our institution between February-2007 and September-2020. Surgical outcomes variables collected included: the rate of Endoscopic-combined intra-renal surgery (ECIRS), operative times, surgical effectiveness (no residuals <2 mm stone fragments) and complications. Results: A total of 592 patients underwent PCNL with a median age of 56 years (IQR: 42–67). The median stone size was 17 mm (IQR: 13–23). Of those, 79% of patients had an effective procedure. Stone size (p < 0.001), location (p < 0.001) and Guys-Stone Score (GSS) (p < 0.001) were associated with effectiveness. A Percutaneous nephrostomy tube was sited at the completion of the procedure in 97.3% of patients and a simultaneous double-J stent in 45.3%. Stent insertion was associated with larger stones (p < 0.001), the performance of ECIRS (p < 0.001) and higher GSS (p < 0.001). The overall complication rate was 21.7%. The main type of complication was an infection in 26.2 of the cases followed by the need for repeated nephrostogram in 12.7%. Conclusions: We demonstrate that PCNL in a high-volume centre is safe and efficacious in the Galdalko modified Valdivia position. Patients with smaller stones in the renal pelvis and a low GSS have the highest chance of a successful procedure. [ABSTRACT FROM AUTHOR]

Percutaneous nephrolithotomy (PCNL) has evolved many a fold and was originally described in supine position by Valdivia et al. In this position, the direction of the tract is posterior and thus preserves a low pressure in the renal pelvis, and thereby reduces the risk of fluid absorption and allows spontaneous clearance/washout of fragments by gravity-directed flow of fluid. Supine PCNL is feasible in most situations. It is an important tool for patients who have musculoskeletal abnormalities precluding prone positioning. It gives the surgeon a simultaneous opportunity to do flexible ureteroscopy. Mobility of the kidney may make the puncture difficult. Suctioning of the dust using the suction sheath in supine PCNL makes the procedure more effective. [ABSTRACT FROM AUTHOR]

Abbreviations DMSA dimercaptosuccinic acid DRF differential renal function ECIRS endoscopic combined intrarenal surgery GMSVP Galdakao-modified supine Valdivia position HSK horseshoe kidney PCNL percutaneous nephrolithotomy US ultrasonography Introduction Horseshoe kidney (HSK) is the most common renal fusion anomaly, with a reported incidence of approximately one in 500 births. (B) Axial CT showing a staghorn stone in the right moiety of a HSK and the nephrostomy pathway. gl After a thorough discussion with the patient regarding different treatment alternatives, staggered PCNL was proposed. Several treatment options can be currently offered to patients with stones in HSKs: shockwave lithotripsy, flexible ureteroscopy, percutaneous nephrolithotomy (PCNL), laparoscopy/robot-assisted and, less commonly, open surgery. "Case of the Month" from the University of Santiago de Compostela, Spain: challenging the status quo in percutaneous stone surgery for horseshoe kidneys, the Galdakao-modified supine Valdivia position is a safe alternative for complex cases. [Extracted from the article]