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[Comparison between Valdivia position and prone position in percutaneous nephrolithotomy].

J H Amón Sesmero¹, N Del Valle González, C Conde Redondo

¹Servicio de Urología, Hospital Rio Hortega, Valladolid. amonsesmero@yahoo.es

Actas Urologicas Espanolas

|June 11, 2008

Summary

The Valdivia (supine) position is as effective as the prone position for percutaneous nephrolithotomy (PNL). Both positions demonstrate similar stone-free rates, complication rates, and operative times for kidney stone removal.

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Area of Science:

Urology
Nephrolithiasis Management
Surgical Techniques

Background:

The supine Valdivia position for percutaneous nephrolithotomy (PNL) offers potential advantages but has limited adoption due to perceived technical challenges.
Comparative studies on PNL positions are scarce, lacking robust data on efficacy and safety.
This study directly compares the supine (Valdivia) and prone positions for PNL.

Purpose of the Study:

To compare the technical difficulties, effectiveness, and complication rates of PNL in supine versus prone positions.
To evaluate the feasibility and outcomes of the Valdivia position in PNL.
To provide data to inform urological practice regarding PNL positioning.

Main Methods:

Retrospective comparison of 50 patients undergoing PNL in the supine position versus 54 patients in the prone position.
Procedures performed under general anesthesia, predominantly using an inferior calyx approach and single tract.
High-pressure balloon catheters used for tract dilation; ultrasonic or ballistic energy for stone fragmentation.

Main Results:

No significant differences in demographic or operative variables between supine and prone groups.
Similar failure rates for kidney access (6% supine vs. 5.56% prone).
Comparable stone-free rates (76% supine vs. 74% prone), operative times, need for secondary treatments, hospital stay, and analgesia requirements.
Low and similar complication rates, with one colon injury in the supine group.

Conclusions:

The Valdivia (supine) position is a feasible alternative to the prone position for PNL.
Both supine and prone PNL yield similar success rates for stone clearance.
Complication rates are comparable between the two PNL positions.