Renal Stones Clinical Trial
Official title:
Prone Flexed Position in Percutanous Nephrolithotomy in Comparsion With Standard Prone Position. A Randomized Controlled Trial.
prone flexed position in percutanous nephrolithotomy in comparsion with standard prone position. A randomized controlled trial.
Patients meeting the inclusion criteria will be randomly allocated to 2 groups:
1. 1st group will undergo prone-flexed PCNL.
2. 2nd group will undergo prone PCNL.
III. Recruitment of participants Patients appointed for an outpatient diagnostic cystoscopy
will be reviewed for the inclusion and exclusion criteria. Legible patients will be asked to
participate in the study and to sign the informed consent form.
IV. Randomisation Randomization will be performed using computer generated random tables
using stratified blocked randomization in 1:1 ratio.
V. Study procedure Preoperative evaluations included
1. Detailed medical history
2. Physical examination
3. Routine blood examination
4. Urinalysis & urine cytology
5. Renal and liver function tests
6. Coagulation profile
8. Computed tomography of the abdomen and pelvis
Operative Technique
Prone-flexed positioning i. Retrograde access will be obtained ii. The patient is
repositioned prone with adequate padding under the pressure points of the head, chest, knees,
and feet.
iii. The table is flexed 30 degrees at the level of the patient's mid lumbar region to open
the space between the 12th rib and the posterior iliac crest dropping the gluteal muscles
from the working plane.
Ancillary intervention
Patients will receive a 20-mL infiltration of 0.25% bupivacaine. Under fluoroscopic guidance,
the local analgesic was infiltrated with a 22-gauge spinal needle (10-cm length) along the
nephrostomy tract at the 3, 6, 9, and 12 o'clock positions (5 mL in each tract), including
the muscles, subcutaneous tissue, and skin.
Patients will receive 1 g tranexamic acid at induction followed by three further doses of 500
mg over the next 24 h.
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