Flank-Free Modified Supine Percutaneous Nephrolithotomy: Our Initial Experience from a Tertiary Care Hospital of North India and the Literature

Objective The main aim of this study was to prospectively analyze and evaluate the safety and efficacy of Flank-Free Modified Supine Percutaneous Nephrolithotripsy (PCNL). Materials and Methods This hospital-based observational study was conducted in the Postgraduate Department of Surgery, Government Medical College, Srinagar. A total of 50 functional renal units were enrolled between 2016 and 2018. Baseline characteristics, puncture position, number of punctures, operation time, stone-free rate, blood loss, hospital stay, and need for secondary intervention were thoroughly studied and monitored. Results Patients ranged from 21–65 years with a mean age of 35.9 ± 9.85 years. The mean stone size was 17.3 ± 1.81 mm (range: 14.2–21 mm). Most patients (40%) had stones measuring 16-17.9 mm. Pelvic stones were found in 28 patients (56%), followed by lower calyx stones in 14 patients (28%), and 8 patients (16%) had stones in both pelvis and lower calyx. The mean operative time was 83.62 ± 16.95 minutes (range: 60–115 minutes). Mean nephrostomy duration was 2.1 days (range: 2–3 days). Three patients (6%) required extracorporeal shock wave lithotripsy (ESWL) as auxiliary treatment. Mean hospital stay was 3.7 ± 1.15 days, with 52% of patients staying 2–3 days. The major complication was need for auxiliary treatment in 3 patients (6%), followed by conversion to prone position and postoperative fever in 2 patients (4%) each. Conclusions Flank-Free Modified Supine PCNL is both effective and safe, offering favorable outcomes regarding patient compliance, urologist ease, and associated complications/morbidity.