Comparative Analysis of Supine and Prone Percutaneous Nephrolithotomy for Efficacy and Safety in Complex Renal Stones...

This study aimed to compare the efficacy and safety of prone and supine percutaneous nephrolithotomy (PCNL) in patients with complex renal stones and anatomical abnormalities.

This retrospective study analysed the data of patients with complex renal stones and anatomical anomalies who underwent PCNL between December 2022 and June 2024. Inclusion criteria encompassed adult patients with complex renal stones (Guy's score 3 or 4), staghorn calculi, diverticular stone, obesity, kyphoscoliosis and solitary kidney or renal anomalies (horseshoe kidney, autosomal dominance polycystic kidney, malrotated kidney, and pelvic kidney). Patients were divided into prone (group P) and supine (group S) groups on the basis of PCNL positioning. Efficiency was evaluated on the basis of stone-free rates (SFRs), and safety was assessed using the Clavien-Dindo complication classification.

A total of 222 patients were included in the study, with 118 patients in group P and 104 patients in group S. No significant differences were observed in stone burden, Hounsfield unit (HU) density or other demographic parameters. Group S had a shorter operative time (105.78 ± 15.71 min) and time to positioning (14.83 ± 12.44 min, p < 0.001) but a longer scopy time (8.13 ± 2.88 min, p < 0.001). The overall SFRs were 77.11% for group P and 75.00% for group S (p = 0.713). Postoperative complications, assessed using the Clavien-Dindo classification, were similar between the groups, with 4.23% major complications in group P and 5.76% in group S.

Supine and prone PCNL demonstrated similar success rates and complication profiles, with supine PCNL offering the advantage of shorter operative times while effectively managing complex cases.