Supine versus Prone Percutaneous Nephrolithotomy: A Comparative Study

Introduction: Nephrolithiasis is a condition that is very common around the world. The gold standard for treating big renal calculi is Percutaneous nephrolithotomy (PCNL), which is often carried out in the prone position. Recently, there has been an increase in interest in supine PCNL in the global endourology arena.Method: This is a prospective comparative study. ۵۳ patients with renal stones underwent PCNL, done by a single expert surgeon, the patients were divided randomly into ۲ groups, ۲۶ of them operated with supine percutaneous nephrolithotomy and ۲۷ with prone percutaneous nephrolithotomy. Patient’s demographics, access time, operative duration, stone-free rate, post-operative hemoglobin drop and complications were compared.Results: The demographics and characteristics of the stones were similar in both groups. The supine position for PCNL demonstrated a notably shorter operative time compared to the prone position for PCNL., ۶۰.۳±۳.۷ min vs ۷۹.۷±۲.۵min (P-value<۰.۰۰۱).  The stone-free rate at ۱-month duration was slightly better for prone, ۲۴ patients (۸۸.۹%) for prone and ۲۲ patients (۸۴.۶%) for supine, but statistically not significant (P-value ۰.۶۴۵). Hospital stays were ۵۰.۳±۶.۷ hr for supine and ۵۲.۶۵±۶.۴ hr for prone respectively (P-value ۰.۱۹۸). Hb drops were comparable, ۱.۲۲±۰.۰۹ in supine and ۱.۲۶±۰.۰۹۶ in prone (P-value ۰.۱۲۴). Post-operative Complications were found to be ۴ patients (۱۵.۴%) of which (۲ with fever and hematuria, and ۲ with hematuria only) occurred in supine while ۵ patients (۱۸.۵%) had occurred in prone group (۱ with fever only, ۲ with fever and hematuria, and ۲ with hematuria only) (P-value ۰.۷۶۱). Patients had no complications Clavien grade III or higher in both groups.Conclusion: Supine PCNL is as safe and effective procedure as prone, with comparable stone-free rate and complications, with added advantage of a significantly lower operative time.

کلیدواژه ها:

Supine PCNL ، Prone PCNL ، renal stones