COMPARISON BETWEEN SUPINE POSITION VERSUS PRONE POSITION IN PERCUTANEOUS NEPHROLITHOTOMY: A SINGLE CENTERED ANALYSIS OF 623 CASES
AbstractBackground: The ideal urological method for treating complex, large renal calculi is Percutaneous nephrolithotomy (PCNL). Its instruments, surgical techniques, and positions have all been adjusted as a result of its ever-changing nature. In PCNL, the supine position is advantageous compared to the prone position due to its several advantages, including the absence of cardiopulmonary risks, fewer post operative complications and shorter operative time. This study was designed for comparison of PCNL in prone and supine positions. Methods: After receiving ethical and research committee approval, this retrospective cohort study (comparative study?) was conducted from 2015 to 2021. Out of 623 patients, PCNL in prone position was performed on 258 patients and 365 patients in modified supine position. The patients' demographics, stone size and location, number of tracts, operating time, hospital stay, stone clearance rate, and post-operative complications were all compared. Results: The gender and age of the patients, the size and number of tracts, and location of the stones were all comparable (p>0.05). Operative time for prone position was 82 min±2.49 SD VS 65 min±2.95 SD, for modified supine position, p<0.001), hospital stay was 58 hrs.±1.66 SD for prone VS 51 Hrs.±1.65 SD, for modified supine position, p<0.01) and analgesia requirements for prone position was 41% VS 23% for modified supine position, p<0.001). The stone clearance rate was 87% in supine position and 89% in the prone positioning group (p=0.47). Urinary leakage from tract site was 0.38% in prone vs. 0% in supine position and temperature >99 °F was 12.4% in prone vs. 11.3% in supine position were the most common post-operative complications. Angioembolization was not observed in either group. Blood transfusions were given to 4.26% in prone position and in 3.58% of cases in supine PCNL. Conclusion: Percutaneous nephrolithotomy in the supine position had a short operating time, short hospital stays, and less analgesia requirements than PCNL in the prone position. In view of the above findings, supine PCNL is easy, quick to perform and having less complications rate as compare to Prone PCNL.
Preminger GM, Assimos DG, Lingeman JE, Nakada SY, Pearle MS, Wolf JS Jr. Chapter 1: AUA guideline on management of staghorn calculi: Diagnosis and treatment recommendations. J Urol 2005;173(6):1991–2000.
Cohen J, Cohen S, Grasso M. Ureteropyeloscopic treatment of large, complex intrarenal and proximal ureteral calculi. BJU Int 2013;111(3 Pt B):E127–31.
Gravenstein D. Extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy. Anesthesiol Clin North Am 2000;18(4):953–71.
Edgcombe H, Carter K, Yarrow S. Anaesthesia in the prone position. Br J Anaesth 2008;100(2):165–83.
Valdivia Uría JG, Valle Gerhold J, López López JA, Villarroya Rodriguez S, Ambroj Navarro C, Ramirez Fabián M, et al. Technique and complications of percutaneous nephroscopy: experience with 557 patients in the supine position. J Urol 1998;160(6 Pt 1):1975–78.
Ibarluzea G, Scoffone CM, Cracco CM, Poggio M, Porpiglia F, Terrone C, et al. Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access. BJU Int 2007;100(1):233–6.
Sofer M, Giusti G, Proietti S, Mintz I, Kabha M, Matzkin H, et al. Upper calyx approachability through a lower calyx access for prone versus supine percutaneous nephrolithotomy. J Urol 2016;195(2):377–82.
Fernstrom I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol 1976;10(3):257–9.
Valdivia JG, Scarpa RM, Duvdevani M, Gross AJ, Nadler RB, Nutahara K, et al. Supine versus prone position during percutaneous nephrolithotomy: a report from the clinical research office of the endourological society percutaneous nephrolithotomy global study. J Endourol 2011;25(10):1619–25.
Falahatkar S, Asli MM, Emadi SA, Enshaei A, Pourhadi H, Allahkhah A. Complete supine percutaneous nephrolithotomy (csPCNL) in patients with and without a history of stone surgery: safety and effectiveness of csPCNL. Urol Res 2011;39(4):295–301.
Ng MT, Sun WH, Cheng CW, Chan ES. Supine position is safe and effective for percutaneous nephrolithotomy. J Endourol 2004;18(5):469–74.
Zhou X, Gao X, Wen J, Xiao C. Clinical value of minimally invasive percutaneous nephrolithotomy in the supine position under the guidance of real-time ultrasound: report of 92 cases. Urol Res 2008;36(2):111–4.
Proietti S, Rodríguez-Socarrás ME, Eisner B, De Coninck V, Sofer M, Saitta G, et al. Supine percutaneous nephrolithotomy: tips and tricks. Transl Androl Urol 2019;8(4):S381–88.
Kumar P, Bach C, Kachrilas S, Papatsoris AG, Buchholz N, Masood J. Supine percutaneous nephrolithotomy (PCNL): ‘in vogue’ but in which position? BJU Int 2012;110(11):E1018–21.
Chapagain A, Basnet RB, Shah C, Shah AK, Shrestha PM, Shrestha A. Comparative Study of Percutaneous Nephrolithotomy in Supine and Prone Positions. J Nepal health Res Counc 2021;19(1):154–7.
Wang Y, Wang Y, Yao Y, Xu N, Zhang H, Chen Q, et al. Prone versus modified supine position in percutaneous nephrolithotomy: a prospective randomized study. Int J Med Sci 2013;10(11):1518–23.
Falahatkar S, Moghaddam AA, Salehi M, Nikpour S, Esmaili F, Khaki N. Complete supine percutaneous nephrolithotripsy comparison with the prone standard technique. J Endourol 2008;22(11):2513–8.
Wu P, Wang L, Wang K. Supine versus prone position in percutaneous nephrolithotomy for kidney calculi: a meta-analysis. Int Urol Nephrol 2011;43(1):67–77.
Liu L, Zheng S, Xu Y, Wei Q. Systematic review and meta-analysis of percutaneous nephrolithotomy for patients in the supine versus prone position. J Endourol 2010;24(12):1941–6.
De Sio M, Autorino R, Quarto G, Calabro F, Damiano R, Giugliano F, et al. Modified supine versus prone position in percutaneous nephrolithotomy for renal stones treatable with a single percutaneous access: a prospective randomized trial. Eur Urol 2008;54(1):196–203.
Yuan D, Liu Y, Rao H, Cheng T, Sun Z, Wang Y, et al. Supine versus prone position in percutaneous nephrolithotomy for kidney calculi: a meta-analysis. J Endourol 2016;30(7):754–63.
Patel RM, Okhunov Z, Clayman RV, Landman J. Prone versus supine percutaneous nephrolithotomy: what is your position? Curr Urol Rep 2017;18(4):26.
Al-Dessoukey AA, Moussa AS, Abdelbary AM, Zayed A, Abdallah R, Elderwy AA, et al. Percutaneous nephrolithotomy in the oblique supine lithotomy position and prone position: a comparative study. J Endourol 2014;28(9):1058–63.
Mazzucchi E, Vicentini FC, Marchini GS, Danilovic A, Brito AH, Srougi M. Percutaneous nephrolithotomy in obese patients: comparison between the prone and total supine position. J Endourol 2012;26(11):1437–42.
Shoma AM, Eraky I, El-Kenawy MR, El-Kappany HA. Percutaneous nephrolithotomy in the supine position: technical aspects and functional outcome compared with the prone technique. Urology 2002;60(3):388–92.