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An updated systematic review and meta-analysis on the efficacy of supine versus prone position for pediatric PCNL
Honggang Fang1,2,3,4, Fuming Zhu1,2,3,4, Kongkong Cui1,2,3,4
1Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.
Insights
Pediatric percutaneous nephrolithotomy (PCNL) in the supine position is more effective than the prone position, reducing operative time, hospital stay, and complications. This approach offers a safer and more efficient option for treating pediatric kidney stones.
Area of Science:
- Pediatric Urology
- Nephrolithiasis Management
- Surgical Techniques
Background:
- Pediatric kidney stone incidence is rising, with high recurrence rates.
- Percutaneous nephrolithotomy (PCNL) is a key treatment, with supine positioning as an alternative to the traditional prone position.
- The supine position offers potential benefits but also carries risks that require evaluation.
Purpose of the Study:
- To conduct an updated systematic review and meta-analysis comparing the efficacy of supine versus prone PCNL in pediatric patients.
- To synthesize current evidence on the outcomes and safety of different PCNL positions in children.
- To provide an evidence-based comparison to guide clinical decision-making.
Main Methods:
- Systematic literature search across major databases (Web of Science, Cochrane Library, PubMed, Embase).
- Data extraction and meta-analysis performed by two independent reviewers using StataMP 17.
- Study adherence to PRISMA guidelines and Cochrane Handbook, registered prospectively in PROSPERO (ID: CRD42024545145).
Main Results:
- Analysis of nine studies (5 RCTs, 4 case-control) involving 614 pediatric patients.
- Supine PCNL showed significant advantages: shorter operative time, reduced hospital stay, lower overall complication rates, and less hemoglobin decrease compared to prone PCNL.
- No significant differences were found in stone clearance, high-grade complications, or radiation exposure time between positions.
Conclusions:
- Supine position PCNL in children is superior to prone PCNL regarding operative time, hospital stay, overall complications, and hemoglobin decrease.
- Subgroup analyses indicated fewer low-grade complications with supine PCNL for small stones, older children, and in studies published post-2024.
- Ultrasound/endoscopy-assisted supine PCNL significantly reduced radiation exposure, supporting its role as a safer, more effective option.
Background:
The incidence of pediatric kidney stones is increasing with recurrence rates ranging from 35 to 50%. Supine percutaneous nephrolithotomy (PCNL) presents a viable alternative to the conventional prone position, offering specific benefits but also posing certain risks.
Objective:
To update a previously published systematic review and meta-analysis comparing the efficacy of PCNL in the supine versus prone positions in children.
Methods:
A systematic search of Web of Science, Cochrane Library, PubMed, and Embase was conducted to identify eligible studies. Two authors independently screened the literature and extracted data. The meta-analysis was performed using StataMP 17. The study was prospectively registered in PROSPERO (ID: CRD42024545145). The sensitivity and subgroup analyses explored sources of heterogeneity, and publication bias was assessed with a funnel plot. The study adhered to PRISMA guidelines and the Cochrane Handbook.
Results:
This study included a total of nine studies, comprising five randomized controlled trials and four case-control studies, with 614 patients in total. Compared with the prone position group, the supine position group demonstrated significant advantages in terms of operative time (WMD = - 15.43, 95% CI: - 22.18 to - 8.69, P = 0.0001), hospital stay (WMD = - 0.77, 95% CI: - 1.12 to - 0.42, P = 0.0001), overall complication rate (OR = 0.46, 95% CI: 0.42-0.99, P = 0.046), and hemoglobin decrease (WMD = - 0.22, 95% CI: - 0.40 to - 0.05, P = 0.013). However, no significant differences were observed between the two groups in stone clearance rate, high-grade complication rate, or radiation exposure time. Subgroup analysis revealed that in studies published after 2024, cases of small stones (< 2 cm), and older children (> 9 years), the supine position group had fewer low-grade complications. Additionally, in the supine PCNL group with ultrasound or endoscopy-assisted puncture, radiation exposure time was significantly reduced.
Conclusion:
This study shows that supine position PCNL in children is superior to the prone position in terms of operative time, hospital stay, complication rate, and hemoglobin decrease, with no significant difference in stone clearance, high-grade complications, or radiation exposure. The subgroup analysis found that supine position resulted in fewer low-grade complications in studies published after 2024, small stones, and older children. It also significantly reduced radiation exposure with ultrasound or endoscopy-assisted puncture, suggesting that supine position is a safer and more effective option.
