INTRODUCTION: although, percutaneous Nephrolithotomy (PCNL) has been usually performed in the prone position but recently other positions like supine and complete supine have been recommended by some endourologists. (1-8) The prone position has numerous disadvantages but a lot of published data have denoted some advantages of the supine PCNL, including less patient handling, easier access to the urethra, position changing in spinal or regional anesthesia is easier, better access to the airway of the patients, easier access to the upper calyces, evacuation of stone fragment, feasibility of simultaneous ureteroscopy, puncture site is far from the fluoroscopy tube, shorter operative time, more comfort for the patient, less risk of colon injury and higher tolerance for pulmonary or cardiovascular disease. (1, 7-8) We aimed to share our experience of the complete supine percutaneous Nephrolithotomy (csPCNL) with others by a video presentation with the details of the technique.

Background: Percutaneous Nephrolithotomy (PCNL) procedures in the United States typically cost between 9000 to 16000 USD. In developing countries like Iran, healthcare performance is hindered by issues such as high bed occupancy rates. Therefore, performing PCNL in an outpatient setting could significantly reduce surgical costs and improve healthcare outcomes by reducing bed occupancy and associated complications. Objectives: This study aimed to explore the feasibility of same-day discharge for selected PCNL patients. Methods: Out of 142 patients, 32 were discharged within 12 hours post-operation (Study Group), while 32 randomly selected patients from the remaining 110 served as the control group. Same-day discharge criteria included stable vital signs, tolerance to oral intake, appropriate mobility, and normal laboratory results. Exclusion criteria encompassed the need for red blood cell transfusion, hemoglobin drops exceeding 2 mg/dL, and abnormal post-operative laboratory findings. Results: Patient characteristics and medical histories did not significantly differ between the study and control groups. Additionally, stone laterality (P-value = 0.606), location (P-value = 0.731), size (P-value = 0.334), and density (P-value = 0.065) showed no significant differences between the two groups. The post-surgical observation period in the study group (mean: 7.88 hours) was significantly shorter than that in the control group (mean: 62 hours) (P-value < 0.001). The mean hemoglobin level change was 1.48 mg/dL (SD: ± 1.02) in the study group and 1.31 mg/dL (SD: ± 0.91) in the control group. Similarly, the change in creatinine levels was 0.13 ± 0.04 in the study group and 0.23 ± 0.03 in the control group. Conclusions: This study demonstrates that outpatient PCNL procedures are feasible without increasing perioperative complications. However, careful patient selection based on strict criteria is crucial for successful implementation.

Percutaneous Nephrolithotomy (PNL) is commonly used to treat patients with complex renal calculi. Placing a nephrostomy tube is the last step after completing PNL. Significant early postoperative discomfort after percutaneous procedure is usually secondary to nephrostomy tubes. The goal of this study is to evaluate the safety of tubeless PNL. A total of 45 patients with mean age of 46.6 years entered the study. Tubeless PNL was performed in 28 patients and 17 patients were treated with standard PNL. The results of 2 groups were compared with t test. In both groups, PNL was performed successfully without any significant complication. Postoperative hospitalization in standard group was 3.71 day and in tubeless group was 1.65 day that significant statistical difference was observed (P < 0.05). Analgesic dose using in standard group was 101.56 mg (pethidine) vs 99.07 mg (pethidine) in tubeless group, with no significant statistical difference. There wasn’t any organ trauma. Rate of complications, including hematuria, extravasation, fever, UTI and urosepsis, didn’t have any significant statistical difference in two groups. It seems that tubeless PNL may be an effective and safe method in renal stone treatment in selected patients. In comparison with standard PNL, tubeless PNL has some benefits including reduction the length of hospitalization. Further studies on more patients are needed to determine the advantages of this technique.

Introduction: The aim of this study was to evaluate percutaneous Nephrolithotomy (PCNL) in the patients with solitary kidneys.Materials and Methods: Between 1995 and 2005, we had 11 patients with a solitary kidney and kidney calculi who underwent PCNL at our center.Tubeless and standard PCNLs were performed in 3 and 7 patients. In 1 patient, we could not achieve access to the system due to the stricture of the infundibulum.Results: The calculi were extracted or fragmented successfully in 10 patients. In 2 patients with residual calculi, a double-J catheter was inserted and extracorporeal shock wave lithotripsy (SWL) was performed. Retroperitoneal hematoma was detected in 3 cases by ultrasonography 1 week after the procedure, which was treated conservatively. Also, fever occurred in 3 patients after the procedure which was treated successfully. The patients were discharged on the 3rd and 4th postoperative days.Conclusion: Although PCNL is accompanied by the risk of complications such as severe bleeding that may result in kidney loss in patients with a solitary kidney, the rate of success and complications seem to be similar to the other patients if careful operation and correct selection of candidates are done. Therefore, we recommend cautious performance of PCNL in patients with solitary kidneys.