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Positioning for percutaneous nephrolithotomy.

Cecilia Maria Cracco1, Peter Alken, Cesare Marco Scoffone

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Patient positioning for percutaneous nephrolithotomy (PNL) has evolved, with both prone and supine positions offering advantages. Endourologists must master both techniques to tailor PNL for diverse patient needs and stone burdens.

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Area of Science:

  • Urology
  • Surgical Techniques
  • Nephrolithotomy

Background:

  • Patient positioning in percutaneous nephrolithotomy (PNL) has evolved significantly.
  • The traditional prone position is widely used but has limitations, particularly for pelvic kidney stones.

Purpose of the Study:

  • To review the evolution of prone and supine positions for PNL.
  • To analyze the advantages and disadvantages of each position.
  • To identify optimal patient candidates and discuss future trends.

Main Methods:

  • Literature review and critical interpretation of studies on PNL positioning.
  • Analysis of historical and current data on prone and supine techniques.

Main Results:

  • PNL positioning is a subject of recent debate, with supine and modified supine positions emerging as alternatives to the traditional prone approach.
  • Both prone and supine PNL are effective, with supine potentially offering anesthesiological safety benefits.
  • Each position presents unique advantages and drawbacks.

Conclusions:

  • The challenge lies in mastering both prone and supine PNL to personalize treatment for all patients, including complex cases and high-risk individuals.
  • Supine PNL requires intensive training due to its lower current adoption rate worldwide.