Percutaneous Nephrostomy in supine position

Percutaneous nephrostomy has traditionally been performed with the patient in the prone position, probably to reduce the risk of injury to adjacent visceral organs, particularly the colon. The prone position, however, is associated with disadvantages such as patient discomfort and circulatory and ventilatory difficulties, particularly in obese patients. We describe a technique of percutaneous nephrostomy with the patient in the supine anterolateral position using local anesthesia, ultrasound-guided puncture, and fluoroscopy-controlled placement. TECHNICAL CONSIDERATIONS The supine anterolateral position was obtained by placing towels under the ipsilateral shoulder and gluteus to elevate the flank approximately 30°, thus providing enough space for ultrasound scanning and ultrasound-guided puncture of the collecting system. The ipsilateral arm was placed over the thorax, and the contralateral arm was used for intravenous perfusion. The ipsilateral leg was flexed slightly, and the contralateral leg was flexed and abducted so that its lateral aspect lay on the table, providing adequate space in case of concomitant transurethral manipulation. In this supine position, the colon falls anteromedially and thus well apart from the puncture paths. In contrast, in the prone position, it is pushed against the lateral surface of the kidney in the way of possible puncture paths. CONCLUSIONS Our experience with 12 consecutive patients showed this technique to be easy, safe, and effective and to prevent the discomfort and ventilation difficulties of the prone position, particularly in obese patients or those in poor general condition or with respiratory problems.