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Percutaneous nephrolithotomy: position, position, position!

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Summary

Percutaneous nephrolithotomy (PCNL) offers various patient positions. Supine PCNL provides better airway control and shorter operation times, while prone PCNL allows broader access and bilateral procedures.

Keywords:
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Area of Science:

  • Urology
  • Surgical Techniques

Background:

  • Percutaneous nephrolithotomy (PCNL) is a standard treatment for large or complex kidney stones.
  • Patient positioning during PCNL has evolved, with traditional prone and alternative supine techniques being evaluated.

Purpose of the Study:

  • To review the general principles of patient positioning in PCNL.
  • To analyze the advantages and disadvantages of different PCNL positions from surgical and anesthetic perspectives.

Main Methods:

  • Literature review of studies comparing prone and supine PCNL techniques.
  • Analysis of position-related benefits and drawbacks for surgical and anesthetic management.

Main Results:

  • Supine PCNL offers improved cardiovascular/airway control and shorter operative times.
  • Prone PCNL provides wider access, better instrument manipulation, and facilitates bilateral procedures.
  • Evidence is limited by case series and lack of randomized controlled trials, especially concerning stone complexity and patient factors.

Conclusions:

  • Both prone and supine PCNL have distinct advantages and limitations.
  • Further research, including randomized controlled trials, is needed to optimize PCNL positioning based on stone characteristics and patient status.
  • Adequate training in both supine and prone techniques is crucial for improving PCNL outcomes.