Assessment of bilateral supine and prone tubeless percutaneous nephrolithotomy

Introduction: To assess the outcome of same-session bilateral tubeless percutaneous nephrolithotomy (BPCNL) in supine and prone positions and to compare them to unilateral tubeless PCNL (UPCNL). Materials and methods: Consecutive PCNL patients treated at two institutions between 2006-2016 were analyzed. Tubeless BPCNL was performed when indicated. Results: Fifty-eight patients underwent BPCNLs [30 supine (SBPCNL) and 28 prone (PBPCNL)], while 1395 patients underwent UPCNLs. Demographics and baseline data were similar for all groups (p > 0.05). SBPCNL had a longer operating time (124 ± 38 minutes versus 105 ± 36 minutes; p = 0.49) and a significantly longer hospital stay (3.6 ± 1.9 versus 2.4 ± 1.3 days, respectively; p = 0.019) in comparison to PBPCNL. Seven planned BPCNLs were converted to UPCNL, resulting in a BPCNL success rate of 58/65 (89%). When compared to UPCNL, BPCNL patients had a significantly increased postoperative creatinine level (0.74 ± 0.3 versus -0.04 ± 0.8 g/dL; p = 0.07E-7), a decreased postoperative hemoglobin level (2 ± 1.1 versus 1.4 ± 1.7 mg/dL; p = 0.026), a higher blood transfusion rate (9% versus 2%; p = 0.023), and a longer hospital stay (3 ± 1.7 versus 1.6 ± 1.7 days; p = 0.001E-4). Stone-free and overall complication rates were similar for both groups. Conclusion: BPCNL can be routinely offered to patients with a bilateral indication. BPCNL is associated with higher blood transfusion rates and longer hospital stays, but it may spare patients from repeat anesthesia and hospitalization. SBPCNL takes longer to perform than PBCNL, but without clinical ramifications.