Percutaneous nephrolithotomy in the supine position: a neglected approach?

Area of Science:

• Urology
• Minimally Invasive Surgery

Background:

• Percutaneous nephrolithotomy (PCNL) is a standard treatment for kidney stones.
• The traditional prone position for PCNL can involve significant patient repositioning and handling.

Purpose of the Study:

• To evaluate the safety and efficacy of single-stage percutaneous nephrolithotomy performed in the supine position.
• To compare the supine PCNL approach with the traditional prone position.

Main Methods:

• Prospective study of 322 consecutive percutaneous nephrolithotomies performed by a single surgeon in the supine position between 1999 and 2006.
• Timed cohort of 27 patients to assess percutaneous access time.

Main Results:

• No complications were directly attributed to the supine position.
• Successful access was achieved in all but one patient.
• Stone clearance rate was 91%, with a transfusion rate of 3.7%.
• Median operative time to percutaneous access was 5 minutes.
• Median hospital stay was reduced to 3 days.

Conclusions:

• Percutaneous nephrolithotomy in the supine position is a safe and effective procedure for the majority of patients.
• The supine position offers potential benefits including easier urethral access, less patient handling, and reduced operative time.