Supine versus Prone Miniaturised Percutaneous Nephrolithotomy in Elderly Patients

Area of Science:

• Urology
• Minimally Invasive Surgery
• Geriatric Medicine

Background:

• Elderly patients present unique challenges for kidney stone treatment.
• Percutaneous nephrolithotomy (PCNL) is effective but associated with complications.
• Miniaturized PCNL (mini-PCNL) aims to reduce morbidity.

Purpose of the Study:

• To compare the outcomes of mini-PCNL in prone versus supine positions in patients over 65.
• To evaluate the safety and efficacy of each position in this demographic.

Main Methods:

• A cohort study comparing 54 patients in the supine group and 64 in the prone group.
• Patients over 65 years were included; Charlson Comorbidity Index (CCI) was calculated.
• Outcomes assessed included perioperative values, stone-free rates, and complication rates (Clavien scoring system).

Main Results:

• No significant difference in stone-free rates or overall complication rates between prone and supine mini-PCNL.
• Grade 1-2 complication rates were significantly higher in the prone group (p=0.020).
• Higher CCI scores and larger stone size were significantly associated with complications (p=0.018 and p=0.034, respectively).

Conclusions:

• Supine mini-PCNL is a potentially safer alternative for geriatric patients, particularly those with high CCI scores.
• This is the first study to directly compare prone and supine mini-PCNL in elderly patients.
• Position choice may be tailored based on patient comorbidities and stone characteristics.