Percutaneous nephrolithotomy in the supine position: a neglected approach?

The aim of the study was to demonstrate the safety and effectiveness of single-stage percutaneous nephrolithotomy performed in the supine position.

A single surgeon performed 322 consecutive percutaneous nephrolithotomies in patients in the supine position between 1999 and 2006, which were studied prospectively.

There were no complications related to the supine position, and in only one patient was there failed access. This patient's kidney was subsequently punctured with the patient in the supine position. There were no colonic injuries, no pneumothoraces, and a transfusion rate of 3.7%. Surgery on all patients with stones, including staghorn calculi and bilateral stones managed synchronously, was in the supine position. The median time to percutaneous access in a timed cohort of 27 patients was 5 minutes. The stone clearance rate was 91%. The median length of hospital stay was reduced from 6 days in the initial unstented patients to 3 days in the study overall when most patients received stents.

Percutaneous nephrolithotomy in the supine position is safe, effective, and suitable for the majority of patients. It offers the potential advantages of better urethral access, less patient handling, and the need to only drape once, thus reducing the overall operative time compared to the traditional prone position.