Buscar en
Actas Urológicas Españolas (English Edition)
Toda la web
Inicio Actas Urológicas Españolas (English Edition) Learning of percutaneous nephrolithotomy in supine position. An observational mu...
Journal Information
Vol. 37. Issue 4.
Pages 214-220 (April 2013)
Share
Share
Download PDF
More article options
ePub
Visits
691
Vol. 37. Issue 4.
Pages 214-220 (April 2013)
Original article
Learning of percutaneous nephrolithotomy in supine position. An observational multicenter study
El aprendizaje de la nefrolitectomía percutánea en posición supina. Estudio observacional multicéntrico
Visits
...
J.H. Amóna,??
Corresponding author
amonsesmero@gmail.com

Corresponding author.
, D. Pérez Fentesb, L. Reselc, J.A. Galánd, A. Serranoe, A. Serveraf, J.L. Alvarez-Osoriog, R. Ballesteroh, E. Caoi, M. Arzozj, P. Navarrok, M. Rigabertl, M. Sánchezm
a Hospital Universitario, Río Hortega, Valladolid, Spain
b Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
c Hospital Clínico San Carlos, Madrid, Spain
d Hospital del Vinalopó, Elche, Alicante, Spain
e Hospital Universitario de Guadalajara, Guadalajara, Spain
f Fundación Hospital de Manacor, Mallorca, Spain
g Hospital Puerta del Mar, Cádiz, Spain
h Hospital Marqués de Valdecilla, Santander, Spain
i Complejo Hospitalario Universitario de Cartagena, Murcia, Spain
j Hospital German Trias i Pujol, Badalona, Barcelona, Spain
k Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
l Hospital Virgen de Arrixaca, Murcia, Spain
m Hospital Universitario Lozano Blesa, Zaragoza, Spain
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Tables (7)
Table 1. Demographic characteristics of the studied patients.
Table 2. Major surgical history of patients and proportion of those with associated anomalies.
Table 3. Types of stone and location, size, and number thereof.
Table 4. Relation between the type of stone and the experience of the surgeons as to the improvement of the learning curve.
Table 5. Antibiotic prophylaxis used.
Table 6. Descriptive characteristics of the intervention.
Table 7. Complications and success rates for the total series and comparative according to experience groups with the procedure.
Show moreShow less
Abstract
Objective

To prospectively study the post-operative results and complications of percutaneous nephrolithotomy (PNL) in supine position to assess difficulty of learning it and how experience affects the results. To establish a relative comparison with the data published in the literature on the prone position.

Material and methods

A prospective observational multicenter study on PNL in Valdivia position or in its Galdakao variant was performed. Demographic variables and specific variables related to the lithiasis were collected. Technical aspects, surgery time, success rate and complications according to the Clavien–Dindo classifications were assessed.

Results

A total of 335 PNL in supine position conducted in 13 Spanish centers were registered from September 2008 to June 2011. The man:woman ratio was 1:1.28 and mean age 51.3±14.5 years. 211 (63%) cases were performed by urologists with experience in ≥50 cases and 124 (37%) by urologists with less experience. Mean operation time was 113.3±46.4min, 106.6±38.2 for the experienced ones vs. 124.9±56.2 in the novice ones (p<0.002). No difference was detected in the mean size of the lithiasis. However, in the experienced group, there was a greater proportion of coraliform cases and multiple lithiasis than in the novice group (p<0.001). Success rate was evaluated, as total absence of lithiasic residuals was 69.6%, without differences between groups (68.2 vs. 71.8%). 102 (30.6%) patients had residual lithiasis and 60 (17,9%) required complementary treatment. Relative global success rate was 82.1% and complications rate 25.4%, without detecting differences between groups. However, the novel group had more major complications (p>0.001).

Conclusion

The PNL in supine position is obtaining rapid and consolidated diffusion in our setting and its effectiveness and safety seem to be equivalent to that described in the literature for PNL in prone position. It is possible to obtain good results with a modest learning curve. The rate of greater complications associated to the procedure decreases with experience.

Keywords:
Percutaneous nephrolithotomy
Supine decubitus
Results
Complications
Learning
Resumen
Objetivo

Estudiar prospectivamente los resultados operatorios y las complicaciones de la nefrolitectomía percutánea (NLP) en posición supina para valorar la dificultad de su aprendizaje y cómo afecta la experiencia a los resultados. Establecer una comparación relativa con los datos publicados en la literatura acerca de la posición en prono.

Material y métodos

Estudio prospectivo observacional multicéntrico sobre NLP en posición de Valdivia o en su variante de Galdácano. Se recogen variables demográficas y variables específicas dependientes de la litiasis. Se valoran aspectos técnicos, tiempo quirúrgico, tasa de éxito y complicaciones según la clasificación de Clavien-Dindo.

Resultados

Desde septiembre de 2008 a junio de 2011 se han registrado 335 NLP en posición supina realizadas en 13 centros españoles. La proporción hombre/mujer fue 1:1,28 y la edad media 51,3±14,5 años; 211 (63%) casos fueron realizados por urólogos con experiencia de ≥50 casos y 124 (37%) por urólogos con menos experiencia. El tiempo operatorio medio fue 113,3±46,4min, 106,6±38,2 en experimentados vs. 124,9±56,2 en noveles (p<0,002). No se detectó diferencia en el tamaño medio de la litiasis, pero en el grupo con experiencia se trató una mayor proporción de casos coraliformes y de litiasis múltiples que en el grupo novel (p<0,001). La tasa de éxito evaluada como ausencia total de restos litiásicos fue 69,6%, sin diferencias entre grupos (68,2 vs. 71,8%). En 102 (30,6%) pacientes hubo litiasis residual, precisando tratamiento complementario 60 (17,9%). La tasa relativa de éxito global fue 82,1% y la tasa de complicaciones 25,4%, sin detectarse diferencias entre grupos. No obstante, el grupo novel presentó mayor número de complicaciones mayores (p>0,001).

Conclusión

La NLP en supino está teniendo una rápida y consolidada difusión en nuestro entorno, y su efectividad y seguridad parece equivalente a la descrita en la literatura para la NLP en prono. Resulta posible conseguir buenos resultados con una modesta curva de aprendizaje. La tasa de complicaciones mayores asociadas al procedimiento disminuye con la experiencia.

Palabras clave:
Nefrolitectomía percutánea
Decúbito supino
Resultados
Complicaciones
Aprendizaje

Article

These are the options to access the full texts of the publication Actas Urológicas Españolas (English Edition)
Subscriber
Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”
Subscribe
Subscribe to

Actas Urológicas Españolas (English Edition)

Purchase
Purchase article

Purchasing article the PDF version will be downloaded

Price 19.34 €

Purchase now
Contact
Phone for subscriptions and reporting of errors
From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
932 415 960
Calls from outside Spain
+34 932 415 960
E-mail
Article options
Tools
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos