Effectiveness of US-Guided PCNL Different Positions in Renal Stones Treatment

Study Overview
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Brief Summary
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The aim of this study is to compare the effectiveness of Ultrasound-Guided Percutaneous nephrolithotomyin different positions supine, prone positions and flank suspend supine position in renal stones treatment.

Detailed Description
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Percutaneous nephrolithotomy (PCNL) has become the choice of modality for the treatment of large and complicated renal calculi. Initially, percutaneous access to the kidney was only performed in the prone position, as described sixty years ago.

Official Title
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A Retrospective Single Centered Cohort Study Comparing The Effectiveness of Ultrasound-Guided PCNL Different Positions in Renal Stones Treatment

Conditions
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Percutaneous Nephrolithotomy, Renal Stones, Ultrasound Therapy; Complications

Intervention / Treatment
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* Procedure: Flank suspended supine position percutaneous nephrolithotomy
* Procedure: Supine percutaneous nephrolithotomy group
* Procedure: Prone percutaneous nephrolithotomy group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients who underwent Percutaneous nephrolithotomy Patient's age from >18 - 70 years old. Body mass index (30-40 kg/m2). Both sex Renal stones diameter ≥2 cm Cardiac patients Exclusion Criteria: Patient refusal. Pregnant women. Patients with renal anomalies. Transplanted kidney. Uncorrected coagulopathy, or active infection.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Flank suspended supine position percutaneous nephrolithotomy<br>This group included 41 patients in flank suspended supine position percutaneous nephrolithotomy. | Procedure: Flank suspended supine position percutaneous nephrolithotomy<br>* The patients will be placed in the supine position with the shoulder and the buttock will be raised by a 3-l bag of water suspending the flank of the affected side. The body contour will be aligned to the edge of the table. The operating table will be adjusted to the jack knife position, with the tip of the lower part of the table will be slightly lowered. The leg of the affected side of the patent will be straightened dorsally flexed and slightly inner rotated, with the knee of the other side will be flexed. The patients will be then immobilized at the chest and the pelvis with two adherent tapes which crossed each other at the abdomen to form a 'V' shape.<br>|
| Supine percutaneous nephrolithotomy group<br>This group included 41 patients in supine percutaneous nephrolithotomy. | Procedure: Supine percutaneous nephrolithotomy group<br>* The patient will remain in the supine position, with the side of interest at the edge of the table, with a small cushion placed under the flank to elevate it 15-20°.<br>|
| Prone percutaneous nephrolithotomy group<br>This group included 41 patients in prone percutaneous nephrolithotomy. | Procedure: Prone percutaneous nephrolithotomy group<br>* Prone percutaneous nephrolithotomy. The prone position (PRON) technique followed these classic steps: patients will be placed in a lithotomy position and a ureteral catheter will be inserted through a rigid cystoscope to perform a retrograde pyelogram. The ureteral catheter will be fixed to a Foley catheter, and then the patient will be repositioned to the prone position with pads under their shoulders.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Stone clearance rate | Comparison of stone clearance rates among different positions (flank suspended supine, supine, and prone) in Ultrasound-Guided Percutaneous Nephrolithotomy (PCNL) for the treatment of renal stones. | 3 months postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Operative time | duration of the Ultrasound-Guided Percutaneous Nephrolithotomy (PCNL) procedure among different positions | Intraoperatively | 
| Complication rates | Comparison of postoperative complications (e.g., bleeding, infection, injury) among the different positions. | 48 hours Postoperatively | 
| Stone-free rates | Comparison of the percentage of patients achieving complete stone clearance among the different positions. | 48 hours Postoperatively |