Supine tubeless upper pole PCNL under spinal anaesthesia: Safety, feasibility and outcomes from a tertiary endourology centre

ObjectiveSupine Percutaneous Nephrolithotomy (PCNL) is being taken up by many urologists in recent times, but there is a tendency to shift to prone PCNL for upper pole puncture. We analyzed the safety, feasibility and outcomes of upper pole access in Supine Percutaneous Nephrolithotomy (sPCNL).Materials and methodsA retrospective review of all patients undergoing sPCNL at a tertiary care center was done from January 2021 to December 2022. Data collection was done from the maintained imaging, laboratory and hospital records. All cases with complete data on upper pole access were included. Data analysis was done with Xlstat2021.Results50 patients with upper pole access were included (64%, 32 with single access and 36%, 18 with multiple accesses). The mean stone size was 23.88 +/- 9.99, mean HU was 1093 +/- 232.83, and the mean operative duration was 67.92 +/- 34.62. Stone clearance rate was 98.82%, with all procedures performed tubeless.The mean haemoglobin drop was 0.75 +/- 0.42 gm/dl with 2 (4%) patients needing a blood transfusion. The overall complication rate was 22% with only 1 Clavien Dindo III complication (1 pleural injury and hydrothorax needing USS guided aspiration) and others being Clavien Dindo I/II complications.Results50 patients with upper pole access were included (64%, 32 with single access and 36%, 18 with multiple accesses). The mean stone size was 23.88 +/- 9.99, mean HU was 1093 +/- 232.83, and the mean operative duration was 67.92 +/- 34.62. Stone clearance rate was 98.82%, with all procedures performed tubeless.The mean haemoglobin drop was 0.75 +/- 0.42 gm/dl with 2 (4%) patients needing a blood transfusion. The overall complication rate was 22% with only 1 Clavien Dindo III complication (1 pleural injury and hydrothorax needing USS guided aspiration) and others being Clavien Dindo I/II complications.ConclusionSupine PCNL is a feasible and safe approach for upper pole access. While the procedure can be done tubeless, these procedures must be done in experienced endourology units.