Prone Versus Supine Percutaneous Nephrolithotomy: What Is Your Position?

Area of Science:

• Urology
• Surgical Innovation

Background:

• Percutaneous nephrolithotomy (PCNL) is the standard for large renal stones.
• Surgical techniques, instruments, and patient positioning for PCNL have evolved.
• Traditionally, PCNL was performed in the prone position, but alternatives have emerged.

Purpose of the Study:

• To review the latest developments in patient positioning for PCNL.
• To evaluate the impact of different positions on PCNL outcomes.

Main Methods:

• Comprehensive literature review.
• Analysis of recent meta-analyses comparing PCNL positions.

Main Results:

• The prone position shows a higher stone-free rate compared to supine positions.
• Complication rates are comparable between prone and supine PCNL.
• Supine positioning facilitates simultaneous retrograde access, achievable also with prone modifications.

Conclusions:

• PCNL can be performed in either prone or supine positions.
• Current data do not demonstrate a significant superiority of one position over the other.
• Patient positioning in PCNL continues to be a subject of ongoing evaluation and refinement.