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Querying the significance of patient position during computerized tomography on the reliability of pre-percutaneous nephrolithotomy planning

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Abstract

Background

Computerized tomography (CT) is considered indispensable in percutaneous nephrolithotomy (PCNL) planning. We aimed to define the reliability of pre-PCNL CT for planning renal access by assessing renal positional changes between supine and prone CTs.

Subjects and methods

CT urographies (CTU) of 30 consecutive patients were reviewed for distances upper pole (UP)–diaphragm, UP–diaphragm attachment, renal pelvis (RP)–lateral body wall, RP- posterior body wall, and lower pole (LP)- anterior–superior iliac spine (ASIS). The posterior and lateral renal axes angles were also calculated.

Results

The most consistent overall movement in transition from prone to supine was backward rotation, as demonstrated by a decrease in distance UP–posterior body wall (p = 0.010) and increase in the posterior renal angle (p < 0.0001). This finding correlated with the patient’s body mass index (BMI) (p = 0.029). The left kidney was more mobile than the right one, moving significantly for five of the measured parameters compared to the right kidney which moved significantly for only two parameters. The UP-diaphragm distance of the left kidney correlated with age (p = 0.014), the RP-lateral wall distance correlated with previous abdominal surgery (p = 0.006), and the RP-posterior wall distance with BMI (p = 0.017). On the right, the UP-diaphragm distance correlated with gender (p = 0.002) and the lateral renal rotation was smaller (p = 0.046).

Conclusions

Kidneys present significant mobility between supine and prone positions. CT assessment should be performed in the position expected during surgery and should be interpreted with caution, while a real-time imaging modality should be used in the operating room.

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Author notes

  1. Ziv Savin have equal contribution with the Ismael Masarwe.

Authors and Affiliations

  1. Endourology Unit, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel

    Ismael Masarwe & Mario Sofer

  2. Department of Urology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel

    Ziv Savin, Karin Lifshitz, Haim Herzberg, Ron Marom, Roy Mano, Ofer Yossepowitch & Mario Sofer

  3. Department of Radiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel

    Aviad Rabinowich & Galit Aviram

  4. Department of Radiology, Bnai Zion Medical Center, Affiliated to The Ruth and Bruce Rappaport Faculty of Medicine, The Technion, Haifa, Israel

    Simona Croitoru

Authors
  1. Ismael Masarwe
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  2. Ziv Savin
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  3. Aviad Rabinowich
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  4. Karin Lifshitz
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  5. Haim Herzberg
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  6. Ron Marom
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  7. Simona Croitoru
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  8. Roy Mano
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  9. Ofer Yossepowitch
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  10. Galit Aviram
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  11. Mario Sofer
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Contributions

IM project initiative, data collection, integration and cooperation between the participating medical centers. ZS data management and analysis. AR radiological design and analysis. KL subanalysis and graphical presentation. HH data collection. RM data collection and analysis. SC radiological interpretation. RM drafting and integrity supervisor. OY overall supervisor. GA study design, technical assistance, radiological interpretation and supervision,manuscript editing. MS study design, protocol development, manuscript writing and editing, overall supervisor.

Corresponding author

Correspondence to Mario Sofer.

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No competing financial interests exist.

Ethical approval

Institutional Review Board (IRB) approval was obtained for this study and patient informed consent was obtained before undergoing the procedures.

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Masarwe, I., Savin, Z., Rabinowich, A. et al. Querying the significance of patient position during computerized tomography on the reliability of pre-percutaneous nephrolithotomy planning. World J Urol 40, 1553–1560 (2022). https://doi.org/10.1007/s00345-022-03990-9

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  • DOI: https://doi.org/10.1007/s00345-022-03990-9

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