Objective: This prospective study aims to compare the outcomes of PCNL with prone position compared to the supine position. Material & Methods: A total of 57 patients treated with PCNL from January 2017-December 2017 were included in the study. Inclusion criteria include patients with kidney stones greater than 20 mm in size measured with KUB imaging (Kidney-Ureter-Bladder) or abdominal NCCT (Non Contrast Computed Tomography) who were willing to be treated with PCNL. The exclusion criteria were patients younger than 17 years of age, patients who refused to surgery, patients with history of PCNL on the same side, patients with blood clotting disorders, pregnancy, and kidney stone in patients with congenital kidney disorders. Patients were randomized to undergo PCNL with prone or supine position. A total of 29 patients were treated with PCNL in prone position and 28 patients were treated in supine position. Data on patient characteristics, puncture location, number of puncture, use of post PCNL nephrostomy, duration of surgery, presence or absence of residual stones measuring ≥5 mm in size, total complications, postoperative fever, sepsis, bleeding requiring transfusion, retroperitoneal hematoma, pleural effusion, intestinal injury, and the difference between hemoglobin count before and after surgery was compared between the two groups. Results: There were no significant differences observed in terms of number, sex, age, BMI, stone size, hydronephrosis, and comorbidities in patients of both groups. Stone free rate in PCNL with prone position and supine position is 82.8% and 92.9% respectively. Significant comparisons were observed on differences in the mean duration of surgery in which PCNL duration of surgery with the prone position was 150 minutes whereas the supine position took 130 minutes (p=0.003). There were no significant differences between successful puncture, total complications, postoperative fever, sepsis, and bleeding requiring transfusion. There were no patients who had pleural effusion, intestinal injury, or death in this study. Conclusion: PCNL in supine position has the same effectiveness and safety as PCNL in prone position. The Stone free rate is higher in PCNL performed in supine position. The duration of PCNL surgery in supine position is significantly shorter than the PCNL prone position.
PCNL, Prone, Supine, Surgery
Modlin M. A history of urinary stone. S Afr Med J. 1980; 58(16): 652–5.
Miller NL, Lingeman JE. Management of kidney stones. Br Med J. 2007; 334(7591): 468–72.
Sutherland J, Parks J, Coe F. Recurrence after a single renal stone in a community practice. Min Electrolyte Metab. 1985; 11: 267–269.
Moe OW. Kidney stones: Pathophysiology and medical management. Lancet. 2006; 367(9507): 333–44.
Ikatan Ahli Urologi Indonesia. Guidelines Penatalaksanaan Penyakit Batu Saluran Kemih. Jakarta: IAUI; 2007.
Türk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, et al. EAU Guidelines on Urolithiasis. European Association of Urology; 2018.
Tugcu V, Su FE, Kalfazade N, Sahin S, Ozbay B, Tasci AI. Percutaneous nephrolithotomy (PCNL) in patients with previous open stone surgery. Int Urol Nephrol. 2008; 40(4): 881–4.
Preminger G, Clayman R, Hardeman S. Percutaneous Nephrostolithotomy VS Open Surgery For Renal Calculi: A Comparative Study. JAMA. 1985; 254: 1054–1058.
Goodwin W, Casey W, Woolf W. Percutaneous Trocar (Needle) Nephrostomy in Hydronephrosis. J Am Med Assoc. 1955; 10: 257–259.
Fernstrom I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol. 1976; 10: 257–259.
Smith A, Lee W. Percutaneous Stone Removal Procedures Including Irrigation. Urol Clin North Am. 1983; 10: 719–27.
Alken P, Hutschenreiter G, Gunther R. Percutaneous Stone Manipulation. J Urol. 1981; 125: 463–6.
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.
Valdivia J, Santamaria E, Villarroya R, Taberner L, Abril B, Aranda L. Percutaneous Nephrolithectomy: Simplified Technic (Preliminary Report). Arch Esp Urol. 1987; 40: 177–80.
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): 1975–8.
Mak DKC, Smith Y, Buchholz N, El-Husseiny T. What is better in percutaneous nephrolithotomy - Prone or supine? A systematic review. Arab J Urol. 2016; 14(2): 101–7.
Falahatkar S, Mokhtari G, Teimoori M. An update on supine versus prone percutaneous nephrolithotomy: A meta-analysis. Urol J. 2016; 13(5): 2814–22.
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.
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.
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.
de la Rosette JJMCH, Tsakiris P, Ferrandino MN, Elsakka AM, Rioja J, Preminger GM. Beyond Prone Position in Percutaneous Nephrolithotomy: A Comprehensive Review. Eur Urol. 2008; 54(6): 1262–9.
Jones MN, Ranasinghe W, Cetti R, Newell B, Chu K, Harper M, et al. Modified supine versus prone percutaneous nephrolithotomy : Surgical outcomes from a tertiary teaching hospital. Investig Clin Urol. 2016; 57: 268–73.
Wein AJ, Kavoussi LR, Campbell MF. Percutaneous Approaches to the Upper Urinary Tract Collecting System. In: Wolf J, editor. Campbell-Walsh Urology. 10th ed. Philadelphia: Elsevier Saunders; 2012. p. 1324–55.
Sohail N, Albodour A, Abdelrahman KM. Percutaneous nephrolithotomy in complete supine flank-free position in comparison to prone position: A single-centre experience. Arab J Urol. 2017; 15(1): 42–7.
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): 2513–7.
Rana AM, Bhojwani JP, Junejo NN, Bhagia SM Das. Tubeless PCNL with Patient in Supine Position: Procedure for all Seasons?-with Comprehensive Technique. Urology. 2008; 71(4): 581–5.
McCahy P, Rzetelski-West K, Gleeson J. Complete Stone Clearance Using a Modified Supine Position: Initial Experience and Comparison with Prone Percutaneous Nephrolithotomy. J Endourol. 2013; 27(6): 705–9.
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.
De Sio M, Autorino R, Quarto G, Calabrò 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.
Rafie MA, Jalal AA, Khudhur H. Supine position is safe and effective for percutaneous nephrolithotomy. Bahrain Med Bull. 2014; 36(1).
Eğilmez T. Fever and Systemic Inflammatory Response Syndrome Seen After Percutaneous Nephrolithotomy: Review of 1290 Adult Patients. J Clin Anal Med. 2015; 6(2): 196–201.
Bansal SS, Pawar PW, Sawant AS, Tamhankar AS, Patil SR, Kasat GV. Predictive factors for fever and sepsis following percutaneous nephrolithotomy: A review of 580 patients. Urol Ann. 2017; 9(3): 230-233.
Chichakli R, Krause R, Voelzke B, Turk T. Incidence of perinephric hematoma after percutaneous nephrolithotomy. J Endourol. 2008; 22(6): 1227–32.
Kamphuis GM, Baard J, Westendarp M, de la Rosette JJMCH. Lessons learned from the CROES percutaneous nephrolithotomy global study. World J Urol. 2014; 33(2): 223–33.
Vicentini FC, Gomes CM, Danilovic A, Neto EAC, Mazzucchi E, Srougi M. Percutaneous Nephrolithotomy: Current Concepts. Indian J Urol. 2009; 25(1): 4–10.