Contralateral knee-flexion prone split-leg percutaneous nephrolithotomy: A versatile technique

This study developed a novel technique for performing percutaneous nephrolithotomy (PCNL) in the knee-flexion prone split-leg (KF-PSL) position; this technique aimed to address the shortcomings of the traditional prone (TP) position and the PSL position. The study evaluated the safety, advantages, and feasibility of the KF-PSL position compared to the TP position.

A novel technique was developed based on the common PSL position. A retrospective analysis was conducted on the data of 276 patients who underwent PCNL in either the KF-PSL or TP position between January 2022 and June 2023. Demographic and perioperative clinical data of the KF-PSL and TP groups were reviewed and compared.

A total of 276 patients were divided into two groups based on the operative position. The preoperative parameters of the two groups did not differ significantly. The mean stone size (represented by the aggregation of the diameter of all the stones) was 40.03 (SD 23.89) mm. Significant differences were found in both the mean operative time (80.9 [SD 47.2] min in KF-PSL vs. 107.3 [SD 57.7] min in TP, p<0.001) and the stone-free rates (73% in KF-PSL vs. 61% in TP, p=0.046). Braden Scale scores of the two groups did not differ significantly (p=0.12). No significant difference was observed between the groups in the total complication rate (p=0.6).

The KF-PSL is a promising modified position for PCNL that allows for a shorter operative time, a higher stone-free rate, and a more simplified surgical procedure compared to the TP position without compromising outcomes. It is more convenient for combined therapy, allowing access to the entire urinary tract without the need for position changes.