Complete Supine Percutaneous Nephrolithotripsy Comparison with the Prone Standard Technique

Purpose: PCNL (percutaneous nephrolithotripsy) is usually performed in the prone position. The supine position has potential advantages comparing with the prone position. Our objective is comparison between the outcome of PCNL in the complete supine position and the standard prone position. Material and Methods: A total of 80 patients who underwent PCNL from February 2008 to June 2008 evaluated in a prospective manner, were randomly divided into two groups: 40 patients underwent prone PCNL and 40 patients underwent complete supine PCNL. We performed complete supine PCNL with no rolled towel under the flank and no change in leg position. Results in both positions were compared regarding technical aspects, operative time, stone free rate, complications and hospital stay, and were analyzed using t-test and chi–square. We considered P < 0.05 as significant. Results: Regardless the position, the pelvicaliceal system could be successfully approached in all patients. Mean operative time in supine group was 74.7 ± 25.1 min and less than prone group (106.87 ± 17.5) with a significant statistical difference (P < 0.0001). Stone free rate was 80% and 77.5% in prone and supine position respectively. Mean hospital stay was similar in both groups. Bleeding requiring transfusion in two groups had not significant statistical difference. We had not colon injury. Conclusion: PCNL in supine position is safe, effective and suitable for the patients. It offers the potential advantages of better urethral access, less patient handling, needing drape only once, ability to perform simultaneous PCNL and ureteroscopic procedures, better control of the airway during procedures, thus reducing over-all operative time compared to traditional prone position and performing PCNL while the surgeon is sitting. It may be considered for most patients requiring PCNL.