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Supine Versus Prone Percutaneous Nephrolithotomy (PCNL): A Single Surgeon's Experience
Deerush Kannan1, Mohsin Quadri2, Praveen G Sekaran3
1Urology, Apollo Hospitals, Chennai, IND.
Cureus
|August 17, 2023
Summary
Supine percutaneous nephrolithotomy (PCNL) offers shorter operative times and less pain compared to prone PCNL. However, prone PCNL may be preferred for complex cases, while supine PCNL is suitable for high-risk patients.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Nephrolithiasis Treatment
Background:
- Percutaneous nephrolithotomy (PCNL) is the gold standard for treating renal calculi >2 cm.
- Both supine and prone positions have advantages, but optimal positioning is debated.
- This study compares surgical outcomes between supine and prone PCNL.
Purpose of the Study:
- To evaluate and compare supine versus prone percutaneous nephrolithotomy (PCNL).
- To assess operative time, success rate, stone clearance, safety, and complications.
- To determine optimal patient selection for each PCNL position.
Main Methods:
- Prospective cohort study of 166 patients (83 supine, 83 prone).
- Conducted in a tertiary care center in South India (Jan 2018 - Oct 2020).
- Patients matched for age, BMI, stone characteristics, comorbidities, and prior surgery.
Main Results:
- Supine PCNL demonstrated reduced operative time and lower pain scores compared to prone.
- Puncture ease was superior in the supine position.
- Higher stone residue was observed in supine PCNL compared to prone.
Conclusions:
- Supine PCNL is advantageous for high-risk patients.
- Prone PCNL is preferred for bilateral procedures, complex anatomy, or larger stone burdens.
- Position choice impacts operative efficiency and outcomes in PCNL.
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