When prone position is contraindicated or not preferable, can supine percutaneous nephrolithotomy solve the problem?

Area of Science:

• Urology
• Minimally Invasive Surgery

Background:

• Percutaneous nephrolithotomy (PCNL) is a standard treatment for kidney stones.
• The prone position is traditionally used for PCNL but may be unsuitable for certain patient groups.

Purpose of the Study:

• To evaluate the safety and efficacy of supine PCNL.
• To assess its suitability for patients with contraindications or preferences against the prone position, including those with comorbidities, obesity, or upper ureteric stones.

Main Methods:

• Fifty-two patients underwent supine PCNL, with access achieved via a modified dorsal lithotomy position.
• Regional or general anesthesia was employed based on patient condition.
• Fluoroscopic guidance was used for percutaneous access to the pelvicalyceal system.

Main Results:

• A 92.3% stone-free rate was achieved.
• Successful renal puncture was accomplished in all cases.
• Complications included bleeding (3.8%), fever (7.7%), deep venous thrombosis (1.9%), and urinary leakage (5.8%).

Conclusions:

• Modified supine PCNL is a safe and effective alternative to the prone position.
• It provides excellent outcomes for patients with morbid obesity and cardiopulmonary compromise.