Does surgical position affect infective complications in percutaneous nephrolithotomy?

Area of Science:

• Urology
• Nephrology
• Surgical Innovation

Background:

• Percutaneous nephrolithotomy (PCNL) is a key procedure for kidney stone removal.
• The prone position has been traditionally favored, but concerns exist regarding intrarenal pressure and complications.
• Supine PCNL offers theoretical advantages in fluid and fragment evacuation.

Purpose of the Study:

• To compare the incidence of infectious complications between prone and supine PCNL.
• To identify risk factors associated with infectious complications during PCNL.

Main Methods:

• Retrospective analysis of 182 patients undergoing PCNL (April 2020 - May 2022).
• Data collected included demographics, stone characteristics, and perioperative outcomes.
• Patients were categorized into prone and supine position groups for comparison.

Main Results:

• Infectious complications occurred in 18% of the prone group versus 7.5% in the supine group (p=0.034).
• Independent risk factors for infection included surgery duration, stone burden, prior urinary tract infection, and prone positioning.
• Prone position was identified as an independent predictor of postoperative infectious events.

Conclusions:

• Supine PCNL is associated with a statistically significant reduction in infectious complications compared to the prone position.
• The study supports the growing trend of adopting supine PCNL as a standard approach.
• Further research may solidify supine PCNL's role in minimizing infectious risks in kidney stone management.