Supine versus prone position in percutaneous nephrolithotomy: a systematic review and meta-analysis

Birowo, Ponco; Tendi, William; Widyahening, Indah Suci; Rasyid, Nur; Atmoko, Widi

doi:10.12688/f1000research.22940.2

Cited by 4 publications

(2 citation statements)

References 20 publications

(6 reference statements)

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“…Different than the previous studies (reference 8 in article), 2 we can state that stone-free rates do not favor prone PCNL, and that the choice of patient position could be tailored according to surgeon's preference. However, in high-risk patients, especially to infectious complications, supine may have a safer profile and may be associated to lower sepsis rates.…”

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et al. 2022

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avoidance of pleura and visceral structures with needle puncture. As upper pole access may be limited due to rib shadowing, interpolar or lower pole calyceal punctures tend to be selected. This may be a foreseeable prerequisite for reliance on flexible nephroscopy for complex stone, but incorporation of thulium mitigates the inefficiency of flexible stone treatment. 1 A more lateral and downward trajectory of the renal sheath associated with supine access encourages drainage of stone fragments and, as the authors postulate, decreases intrarenal pressure which may explain better stone clearance and lowered rate of urinary sepsis. An upright seated posture for supine PCNL confers better ergonomics enjoyed by both surgeon and trainees. Lastly, familiarity with both supine and prone PCNL allows for flexibility of access when treating the toughest of cases.Ultimately, the selection of positioning will be based on the surgeon's training and comfort level, but I firmly predict a rising trend of supine PCNL with emergence of strong data as presented by the authors.

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“…Many studies have reported that the PP was associated with a higher stone-free rate compared with the supine position [21][22][23]. This might be related to the following reasons.…”

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Oblique supine position versus prone position for percutaneous nephrolithotomy: a systematic review and meta-analysis

Wang¹,

Zhan²,

Chang³

et al. 2023

wiitm

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Introduction: To compare the efficacy and safety of percutaneous nephrolithotomy (PCNL) in the oblique supine position (OSP) and the prone position (PP).Aim: To perform a systematic review and meta-analysis to evaluate the efficacy and safety of OSP versus PP for PCNL. Material and methods: A systematic literature search of PubMed, Ovid, SCOPUS, and citation lists was conducted to identify eligible comparative studies up to November 2022. All studies comparing OSP versus PP for PCNL were included. Statistical analysis was performed with the Collaboration's Review Manager (RevMan) 5.4 software. Results: Overall, eight studies were included involving 1185 patients (OSP = 634; PP = 551). There were no statistically significant differences between OSP and PP in age (WMD = -0.95 years; 95% CI: -2.12 to 0.21; p = 0.83) or proportion of male patients (OR = 0.02; 95% CI: -0.03 to 0.08; p = 0.43). We found that OSP was performed more frequently for smaller stone size and patients with higher BMI (WMD = -0.1 cm, 95%

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Does surgical position affect infective complications in percutaneous nephrolithotomy?

Kasap

Şenel

Uzun

et al. 2022

Preprint

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The downward orientation of the access sheath during supine percutaneous nephrolithotomy (PCNL) allows the faster evacuation of fluids and stone fragments. It theoretically can contribute to the reduction of the high intrarenal pressure-associated complications. We aimed to investigate whether there is a difference between prone and supine PCNL in terms of infective complications. This retrospective study includes 182 patients who underwent supine and prone PCNL due to kidney stones in our clinic between April 2020 and May 2022. Demographic (age, sex, body mass index, comorbidities), radiological (cumulative stone burden, stone density, number of stones, stone localization, stone laterality, presence of hydronephrosis), clinical (previous stone surgery, previous urinary tract) and perioperative (prone or supine position, surgery duration, hospitalization, success, non-infective and infective complications) data of all patients were evaluated. All patients were divided into two groups, the prone position group, and the supine position group. These two groups were compared in terms of pre and post-operative data above. Infective complications were observed in 16 (18%) patients in the prone position group and in 7 (7.5%) patients in the supine position group, and this difference was statistically significant (p = 0.034). Surgery duration (OR = 1.041;95% Cl = 1.021–1.061; p < 0.001), number of stones (OR = 4.09;95% Cl = 1.093–7.309; p = 0.036), previous urinary tract infection (OR = 6.272;95% CI = 1.936–9.317; p = 0.002) and prone position (OR = 4.511;95% CI = 1.265–7.087; p = 0.02) were found as independent risk factors for infective complications. Prone position was proved as an independent predictor of postoperative infectious events. Supine PCNL will be further adopted as the standard PCNL approach by a continuously growing proportion of endourologists.

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Supine versus prone position in percutaneous nephrolithotomy: a systematic review and meta-analysis

Cited by 4 publications

References 20 publications

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Oblique supine position versus prone position for percutaneous nephrolithotomy: a systematic review and meta-analysis

Does surgical position affect infective complications in percutaneous nephrolithotomy?

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