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

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.