MP69-17 IMPACT OF THE PATIENT POSITION ON COMPLICATION RATES OF PERCUTANEOUS NEPHROLITHOTOMY FOR COMPLEX STONES: A RANDOMIZED STUDY

Abstract

INTRODUCTION AND OBJECTIVE: Supine PCNL has been accepted as a good option for treating kidney stones, however, there are some concerns regarding its use for complex stones. The aim of this study is to prospectively evaluate the impact of patient position during PCNL for complex stones on complication rates. METHODS: A randomized bi‐centric controled study of patients that underwent to PCNL for complex kidney stones from May 2018 to June 2019. Patients were divided in 2 groups according positioning during PCNL: supine (SUP) or prone (PRO) position. All other surgical aspects were the same between groups. The variables analyzed were demographic (gender, age, body mass index (BMI), ASA score, Guy's Stone Score ‐ GSS), operative (number of punctures, calyx puncture site, supracostal access, mean operative time, hospitalization time) and safety (complications, punciton culture, stone culture). Complex cases were defined as GSS 3 or 4 based on preoperative CT scan analysis. Complications were graded according to the modified Clavien Classification. Univariate and multivariate analysis including all variables was performed to determine wich parameters were significantly. RESULTS: We studied a total of 112 patients. The demographic and the baseline characteristics were comparable in both groups. SUP had lower mean operative time (117.9±39.1 vs 147.6±38.8; p<0.001, minutes) and lower hospital stay (20.3‐165 vs 30.2‐238.2; p=0.049, hours). PRO had more sepsis (17.9% vs 3.6%; p=0.029), more thoracic complications (14.3% vs 3.6%; p=0.033) and more Clavien ≥ 3 complications (14.3% vs 3.6%; p=0.033) (Table 1). On multivariate number of puncture (OR: 4,37 p=0,005) and puncture culture (OR: 31.17 p=0.001) significantly influenced sepsis (Table 2). CONCLUSIONS: In this randomized study, supine position was associated with a safer profile than prone during PCNL for complex stones. (Figure Presented).