Which position is more advantageous for percutaneous nephrolithotomy: supine or prone?

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrolithiasis Management

Background:

• Percutaneous nephrolithotomy (PNL) is a standard treatment for kidney stones.
• Traditionally performed in the prone position, PNL can also be adapted to a supine position.
• Evaluating the supine position's benefits is crucial for surgical technique advancement.

Purpose of the Study:

• To compare the convenience and advantages of supine percutaneous nephrolithotomy (PNL) versus prone PNL.
• To assess operative and post-operative outcomes, particularly for mini-PNL (mPNL).
• To evaluate the feasibility of transitioning surgical positioning in PNL procedures.

Main Methods:

• Retrospective review of 94 patients undergoing supine PNL (Group-1) and 93 patients undergoing prone PNL (Group-2).
• Focus on mini-PNL (mPNL) subgroups: 77 in supine (Group-1A) and 53 in prone (Group-2A).
• Comparison of demographic data, operative times, fluoroscopy duration, double-J stent (DJS) insertion rates, success rates, and complications.

Main Results:

• Operation time was comparable between supine mPNL (74.4 min) and prone mPNL (79.2 min) (p=0.076).
• Supine mPNL showed significantly shorter median fluoroscopy time (30s vs 40s, p=0.003).
• Supine mPNL had significantly lower intraoperative double-J stent (DJS) insertion rates (23.4% vs 54.7%, p<0.001) and a higher rate of mPNL (81.9% vs 57%, p<0.001).

Conclusions:

• The supine position for PNL, especially mPNL, demonstrates advantages including reduced fluoroscopy time and fewer DJS insertions.
• The supine approach facilitates a higher adoption of minimally invasive PNL techniques.
• No significant differences in mPNL success rates or complication profiles were observed between supine and prone positions.