Split-leg modified lateral versus prone position in percutaneous nephrolithotomy: a prospective, randomized trial.

Area of Science:

• Urology
• Surgical Innovation
• Nephrolithotomy Techniques

Background:

• Standard prone position (PP) for percutaneous nephrolithotomy (PNL) presents several challenges and drawbacks.
• Exploring alternative patient positions can optimize surgical outcomes and patient safety.

Purpose of the Study:

• To compare the efficacy and safety of PNL performed in a split-leg modified lateral position (SL-MLP) versus the standard prone position (PP).

Main Methods:

• A prospective, randomized, unblind, double-arm trial was conducted with adult patients undergoing PNL.
• Patients were stratified and randomized into either the SL-MLP group or the PP group.
• Key outcomes measured included stone-free rate (SFR), operative time, track formation time, fluoroscopy time, and complication rates.

Main Results:

• The stone-free rate was comparable between the SL-MLP group (75.4%) and the PP group (77.8%).
• The SL-MLP group demonstrated a significantly shorter mean total operative time (55.33 min) compared to the PP group (98.49 min).
• No significant differences were observed in fluoroscopy time, total complication rates, hemoglobin reduction, or need for blood transfusion between the groups.

Conclusions:

• SL-MLP PNL is associated with a shorter operative time while maintaining similar stone-free rates and complication profiles compared to standard PP PNL.
• The SL-MLP technique facilitates antegrade and retrograde access to the urinary tract without the need for patient repositioning, enhancing procedural flexibility.