Published 2021-01-15
Ferry Safriadi Dadan Ramdhan


Objective: This study aims to compare outcomes of supine percutaneous nephrolithotomy to prone percutaneous nephrolithotomy as a traditional approach in Hasan Sadikin Hospital Bandung. Material & Methods: Data was taken from urology’s database between 2003-2012, which contain data of prone position (2003-2007), and supine position (2008-2012). Three hundred forty-nine patients were included in this study. We reviewed data on demography, stone burden, operating time, stone-free rate, transfusion rate, hospital stay, and major complications. Results: Of 174 patients underwent prone position, and 175 patients were part of the supine position. Age means of prone position was 51.0 years old, the supine position was 50.5 years old. The number of male patients was 65.5% for prone, and 66.1% for supine. The mean stone's largest diameter of prone was 23.87 mm, supine was 22.36 mm. The operating time of prone was 107 minutes; supine was 90 minutes. The stone-free rate of prone was 94.7%; supine was 91.3%. The mean hospital stays of prone was 14.3 days; supine was 9.6 days. The transfusion rate of prone position was 8.9%, supine was 7.2%. No major complications were recorded. Conclusion: Higher stone-free rates are achieved with patients in the prone position during PCNL. Supine position has shorter operating time, and hospital stay, lower blood transfusion rates. The complication rate is not different between the two positions.   



Percutaneous nephrolithotomy, prone, supine position


Fernstrom I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol. 1976; 10(3): 257-9.

Goodwin WE, Casey WC, Woolf W. Percutaneous trocar (needle) nephrostomy in hydronephrosis. J Am Med Assoc. 1955; 157(11): 891-4.

Turk C, Petrik A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2016; 69(3): 475-82.

Valdivia Uria JG, Lachares Santamaria E, Villarroya Rodriguez S, Taberner Llop J, Abril Baquero G, Aranda Lassa JM. [Percutaneous nephrolithotomy: simplified technic (preliminary report)]. Arch Esp Urol. 1987; 40(3): 177-80.

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.

Hoznek A, Rode J, Ouzaid I, Faraj B, Kimuli M, de la Taille A, et al. Modified supine percutaneous nephrolithotomy for large kidney and ureteral stones: technique and results. Eur Urol. 2012; 61(1): 164-70.

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): 196-202.

Manohar T, Jain P, Desai M. Supine percutaneous nephrolithotomy: Effective approach to high-risk and morbidly obese patients. J Endourol. 2007; 21(1): 44-9.

Scoffone CM, Cracco CM, Cossu M, Grande S, Poggio M, Scarpa RM. Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: a new standard for percutaneous nephrolithotomy? Eur Urol. 2008; 54(6): 1393-403.

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.

Steele D, Marshall V. Percutaneous nephrolithotomy in the supine position: a neglected approach? J Endourol. 2007; 21(12): 1433-7.

Worster A, Preyra I, Weaver B, Haines T. The accuracy of noncontrast helical computed tomography versus intravenous pyelography in the diagnosis of suspected acute urolithiasis: a meta-analysis. Ann Emerg Med. 2002; 40(3): 280-6.

Somani BK, Desai M, Traxer O, Lahme S. Stone-free rate (SFR): a new proposal for defining levels of SFR. Urolithiasis. 2014; 42(2): 95.

Bolliger M, Kroehnert JA, Molineus F, Kandioler D, Schindl M, Riss P. Experiences with the standardized classification of surgical complications (Clavien-Dindo) in general surgery patients. Eur Surg. 2018; 50(6): 256-61.

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.

Falahatkar S, Mokhtari G, Teimoori M. An Update on Supine Versus Prone Percutaneous Nephrolithotomy: A Meta-analysis. Urol J. 2016; 13(5): 2814-22.

Sofer M, Tavdi E, Levi O, Mintz I, Bar-Yosef Y, Sidi A, et al. Implementation of supine percutaneous nephrolithotomy: a novel position for an old operation. Cent European J Urol. 2017; 70(1): 60-65.

Melo PAS, Vicentini FC, Perrella R, Murta CB, Claro JFA. Comparative study of percutaneous nephrolithotomy performed in the traditional prone position and in three different supine positions. Int Braz J Urol. 2019; 45(1): 108-17.

Ramadhan RM, Safriadi, F. Supine Percutaneous Nephrolitotripsy in Hasan Sadikin Hospital. Bandung: Universitas Padjadjaran; 2013.

Astroza G, Lipkin M, Neisius A, Preminger G, De Sio M, Sodha H, et al. Effect of supine vs prone position on outcomes of percutaneous nephrolithotomy in staghorn calculi: results from the Clinical Research Office of the Endourology Society Study. Urology. 2013; 82(6): 1240-4.

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Department of Urology, Faculty of Medicine/Airlangga University