Supine Versus Prone Percutaneous Nephrolithotomy (PCNL): A Single Surgeon's Experience

Percutaneous nephrolithotomy (PCNL) is one of the greatest advances in the field of urology and has been considered the gold standard in the treatment of renal calculi of more than 2 cm in size. While both the supine and prone positions offer their unique advantages, it is still being debated which position offers the most in terms of surgical outcomes. We have evaluated the two approaches in terms of operative time, success rate, stone clearance rate, safety, and complications.

This prospective cohort study was done in the urology department of a tertiary care center in South India between January 2018 and October 2020. A total of 166 patients, with 83 in supine and 83 in prone positions, were included in the study.

Both groups were matched in terms of age, body mass index, stone size and location, co-morbidities, medications taken, presence of diverticular stone, history of surgery, and baseline creatinine level. Mean operative time and pain scores were noted to be less in supine position as compared to prone. Ease of puncture was superior in supine position. Stone residue was noted to be higher in supine PCNL as well.

Supine PCNLs are preferred in high-risk patients while the prone position is preferred in bilateral PCNLs, complex anatomy, or larger stone burden.