Beyond prone position in percutaneous nephrolithotomy: a comprehensive review.

Area of Science:

• Urology
• Surgical Techniques
• Nephrolithiasis Management

Background:

• Percutaneous nephrolithotomy (PNL) is a standard procedure for kidney stone removal.
• Traditionally, PNL is performed with the patient in the prone position.

Purpose of the Study:

• To compare the efficacy and safety of prone versus supine PNL.
• To specifically evaluate outcomes in obese patients and those with staghorn calculi.

Main Methods:

• A comprehensive Medline search was conducted for PNL studies published in the last 10 years.
• Articles focusing on prone and supine PNL positions were analyzed.

Main Results:

• Supine PNL showed no visceral injuries, with transfusion rates of 0.0-9.4% and stone-free rates of 69.6-95.0%.
• Prone PNL in obese patients reported transfusion rates of 3.2-8.8% and stone-free rates of 79.0-89.2%.
• While supine PNL had shorter operative times in non-obese, non-staghorn cases, prone PNL demonstrated slightly better outcomes for staghorn calculi and overall weighted means.

Conclusions:

• For obese patients and those with staghorn calculi, prone PNL is associated with reduced operative times, similar bleeding rates, and slightly superior stone-free rates compared to supine PNL.