How well tolerated is supine percutaneous nephrolithotomy?

Area of Science:

• Urology
• Nephrolithotomy Techniques
• Surgical Positioning

Background:

• Percutaneous nephrolithotomy (PCNL) is a common procedure for kidney stones.
• Supine PCNL, described in 1988, has seen limited adoption despite potential advantages.
• Resistance to supine positioning may stem from inexperience and concerns about complications.

Purpose of the Study:

• To review recent literature on supine percutaneous nephrolithotomy (PCNL).
• To evaluate the benefits and safety of supine PCNL compared to traditional methods.
• To understand the reasons for the limited use of supine PCNL.

Main Methods:

• Review of recent literature on supine PCNL.
• Analysis of studies reporting on efficacy and safety of PCNL techniques.
• Examination of anesthesiologic and anatomical considerations for supine positioning.

Main Results:

• Theoretical anesthesiologic and anatomical advantages exist for supine PCNL, particularly in high-risk patients.
• No prospective randomized studies definitively prove superiority of supine over prone PCNL.
• Current evidence from retrospective reports and global studies suggests comparable efficacy and safety, but not yet proven differences.

Conclusions:

• Supine PCNL demonstrates advantages in specific patient populations.
• The choice between supine and prone positioning depends on individual patient characteristics.
• Surgeon preference and experience are critical factors in deciding the optimal patient position for PCNL.