Application Of Modified Prone Split-leg Position In The Treatment Of Complex Upper Urinary Calculi By Endoscopic Combined Retrograde Intrarenal Surgery

Background and objective:Urinary calculi are one of the most common diseases of urinary.Calculi whose diameters are above 3.0 cm,or solitary kidney stone,multiple renal calculi and staghorn stones are called complex upper urinary stone.PCNL is the main method in the treatment of complex upper urinary stone.Nowadays,the operation position of PCNL includes prone position,supine position,lateral position and oblique supine position.The operation positions of endoscopic combined retrograde intrarenal surgery are split-leg lateral position,supine position and prone split-leg position.At the beginning,we used prone split-leg position in the endoscopic combined retrograde intrarenal surgery.But we found some problems in clinical practice,such as the difficulty to enter the urethral,the comfort level of the operators.Thus,we modified prone split-leg position.The aim of the research is to investigate the application effect of modified prone split-leg position in the treatment of complex upper urinary calculi by endoscopic combined retrograde intrarenal surgery.Materials and Methods A retrospective analysis of 430 patients who were diagnosed as renal calculi or renal calculi combined with upper ureteral calculi and underwent traditional PCNL from March,2016 to September,2017,and 78 patients who were diagnosed as complex upper urinary calculi and underwent endoscopic combined retrograde intrarenal surgery in prone split-leg position and modified prone split-leg position.A prospective analysis of 30 patients who were diagnosed as complex upper urinary calculi and underwent PCNL or endoscopic combined retrograde intrarenal surgery in prone split-leg position and modified prone split-leg position from June,2019 to September,2019 was also conducted.All patients had CT scan to confirm the size and location the calculi.The data include sex,ages,blood pressure,heart rate and oxyhemoglobin saturation was collected.Results All the operations were carried out successfully.The operation time of the 430 patients who underwent traditional PCNL was 1.58+1.63 h.The decrease of hemoglobin before and after operation was 15±8.2g/L.The WBC increasing ratio was1.8±0.56 and the SFR was 82.33%.The operation time of 40 patients who underwent endoscopic combined retrograde intrarenal surgery in prone split-leg position was1.61±0.29 h.The decrease of Hb after operation was 26.3±21.1g/L,The WBC increasing ratio was 1.30±0.46 and the SFR was 87.5%,The average hospital stay after operation were 7.4±1.1 days.Operation time of patient in modified prone split-leg position was 1.37±0.23 h,The decrease of Hb was 15.8±13.1g/L,WBC increasing ratio was 1.28±0.38.The SFR was 89.47%,The average hospital stay after operation were 6.1±1.0days.Statistics analysis showed that the operation time,Hb lose and hospital stay between two groups had statistical significance.All the results showed that compared with traditional split-leg position,operations under the modified split-leg position could shorten operation time,decrease blood lose,reduce complications as well as accelerate recovery.In the prospective analysis,all the operations were carried out successfully.The operation time of traditional PCNL group and the modified split-leg group were1.58±0.69 h 1.32±0.48 h respectively.The time of position changing were6.65±4.24 min and 3.23±2.57 min.The decrease of Hb after operation were15.37±10.51g/L and 10.81±6.36 g/L.The SFR were 86.67% and 93.33% And the hospital stay after operation were 7.25±1.04 d and 6.89±1.21 d.The data showed the time of position changing,decrease of Hb,the indicators of infection and hospital stay of two groups had statistical significance.These results demonstrated that the modified split-leg position could be easily put into practise.Operation under this position have high SFR and lower blood lose.Conclusion Endoscopic combined retrograde intrarenal surgery is useful in treatment of complex upper urinary calculi and modified prone split-leg position is an safe and efficient operation in Endoscopic combined retrograde intrarenal surgery.