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

Background: The decision for using supine or prone position in percutaneous nephrolithotomy (PCNL) is still debatable. The aim of this study is to compare the efficacy and safety profile of the supine and prone position when performing PCNL. Methods: A systematic electronic search was performed using the database from MEDLINE, Cochrane library and Google Scholar from January 2009 to November 2019. The outcomes assessed were stone free rate, major complication rate, length of hospital stay and mean operation time. Results: A total of 11 articles were included in qualitative and quantitative analysis. The efficacy of PCNL in supine position as determined by stone free rate is significantly lower than in prone position (OR: 0.74; 95% CI: 0.66 – 0.83; p<0.00001), However, major complication rate is also lower in the supine group compared with the prone group (OR: 0.70; 95% CI: 0.51 – 0.96; p=0.03). There is no statistically significant difference in the length of hospital stay and mean operation time between both groups. Conclusion: Prone position leads to a higher stone free rate, but also a higher rate of major complication. Thus, the decision of using which position during PCNL should be based on the surgeon’s experience and clinical aspects of the patients.

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

F1000Research ◽

10.12688/f1000research.22940.1 ◽

2020 ◽

Vol 9 ◽

pp. 231 ◽

Cited By ~ 2

Author(s):

Ponco Birowo ◽

William Tendi ◽

Indah S. Widyahening ◽

Nur Rasyid ◽

Widi Atmoko

Keyword(s):

Hospital Stay ◽

Prone Position ◽

Percutaneous Nephrolithotomy ◽

Complication Rate ◽

Length Of Hospital Stay ◽

Operation Time ◽

Major Complication ◽

Stone Free Rate ◽

Major Complication Rate ◽

Free Rate

Background: The decision for using supine or prone position in percutaneous nephrolithotomy (PCNL) is still debatable. The aim of this study is to compare the efficacy and safety profile of the supine and prone position when performing PCNL. Methods: A systematic electronic search was performed using the database from MEDLINE, Cochrane library and Google Scholar from January 2009 to November 2019. The outcomes assessed were stone free rate, major complication rate, length of hospital stay and mean operation time. Results: A total of 11 articles were included in qualitative and quantitative analysis. The efficacy of PCNL in supine position as determined by stone free rate is significantly lower than in prone position (OR: 0.74; 95% CI: 0.66 – 0.83; p<0.00001), However, major complication rate is also lower in the supine group compared with the prone group (OR: 0.70; 95% CI: 0.51 – 0.96; p=0.03). There is no statistically significant difference in the length of hospital stay and mean operation time between both groups. Conclusion: Prone position leads to a higher stone free rate, but also a higher rate of major complication. Thus, the decision of using which position during PCNL should be based on the surgeon’s experience and clinical aspects of the patients.

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The feasibility of one-day length of hospital stay after pediatric percutaneous nephrolithotomy

Urologia Journal ◽

10.1177/0391560321993594 ◽

2021 ◽

pp. 039156032199359

Author(s):

Mohammed Saber-Khalah ◽

A.M. Reyad ◽

Wael Gamal ◽

Hazem Elmoghazy ◽

Ahmed Mamdouh Abd Elhamed ◽

...

Keyword(s):

Multivariate Analysis ◽

Hospital Stay ◽

Percutaneous Nephrolithotomy ◽

Surgical Complications ◽

Length Of Hospital Stay ◽

Day Length ◽

P Value ◽

Stone Free Rate ◽

Tube Removal ◽

Free Rate

Purpose: To evaluate the safety of one-day length of hospital stay (LOS) after pediatric percutaneous nephrolithotomy (PNL), and to study the predictors of LOS. Methods: A retrospective study included pediatric patients who PNL for renal calculi more than 1 cm between January 2016 and October 2019. PNL was performed in prone position. The nephrostomy tubes and ureteric catheters were removed on the second day and patients were discharged if there was no perforation or significant residual stones. The stone free rate, LOS and the surgical complications were reported. Bivariate and multivariate analysis were used to predict the LOS. Results: 220 patients were identified. The median age (range) was eight (Range: 3–17) years. Stone free rate was achieved in 200 patients (91%) of patients, while residual fragments were detected in 20 patients (9%). Complications, they were reported in 50 (22.7%) patients. 184 (83.6%) of patients stayed at the hospital for only 1 day, while 36 (16. 4%) stayed more than 1 day. Of 36 patients who stayed more than one-day, 34 had complications ( p value <0.001). On multivariate analysis, surgical complications was found to be the only predictor of longer LOS ( p value <0.001). Conclusion: Early nephrostomy tube removal and 1-day length of hospital stay could be a safe option after pediatric PNL. Surgical complications is a statistically significant predictor of longer LOS.

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A Percutaneous Nephrolithotripsy Performed in the Oblique Supine Lithotomy Position: A Better Choice

Surgical Innovation ◽

10.1177/15533506211041895 ◽

2021 ◽

pp. 155335062110418

Author(s):

Runpei Deng ◽

Xueyang Huang ◽

Yonglin Xiao ◽

Lei Meng ◽

Jun Wang

Keyword(s):

Blood Loss ◽

Prone Position ◽

Percutaneous Nephrolithotomy ◽

Urinary Calculi ◽

Operation Time ◽

Control Group ◽

Lithotomy Position ◽

Clinical Indicators ◽

Stone Free Rate ◽

Free Rate

Objective. To investigate the efficacy and safety of the oblique supine lithotomy during percutaneous nephrolithotomy (PCNL) to treat upper urinary calculi. Methods. Clinical data were retrospectively analyzed for 371 patients with upper urinary calculi who underwent PCNL at The First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2017 to October 2020. Based on different positions, patients were divided into the observation group (oblique supine lithotomy position, 155 cases, Group 1) or control group (prone position, 216 cases, Group 2). Groups were compared for effectiveness, complications, bleeding, surgical time, clinical indicators, and hospitalization time. Results. There were no significant differences in the clinical baseline data between the two groups ( p > .05). However, the stone-free rate for patients was significantly higher in the observation than in the control group ( p < .05). Both operation time and hospital stay time were significantly lower in the observation versus the control groups ( p < .05). No significant differences were observed for complications or amount of blood loss ( p > .05). Conclusion. In patients with upper urinary calculi, percutaneous nephrolithotomy in the oblique supine lithotomy position has a higher stone-free rate than the prone position. This approach can shorten the operation and provide better comfort and quicker recovery to the patients. A further advantage is that there is no difference in safety and blood loss between the prone position and the oblique lithotomy position.

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TRANSITION FROM PRONE TO SUPINE PERCUTANEOUS NEPHROLITOTOMY: EVALUATING THE LEARNING CURVE FROM THE SINGLE SURGEON EXPERIENCE

Indonesian Journal of Urology ◽

10.32421/juri.v28i2.680 ◽

2021 ◽

Vol 28 (2) ◽

pp. 147-152

Author(s):

Zulfikar Ali ◽

Andika Afriansyah

Keyword(s):

Learning Curve ◽

Hospital Stay ◽

Operative Time ◽

Length Of Hospital Stay ◽

Major Complication ◽

Hemoglobin Level ◽

Stone Free Rate ◽

Surgeon Experience ◽

The Mean ◽

Free Rate

Objective: This study aims to evaluate the learning curve of the urologist to perform supine PCNL and the perioperative outcome of patients based on a single surgeon’s experience. Material & Methods: 60 consecutive patients who underwent modified supine PCNL for renal stone were analyzed. A single experienced urological surgeon performed the supine PCNL. Mean operative time, drop in hemoglobin level, stone-free rate, complications, and length of hospital stay were analyzed to evaluate the learning curve of the surgeon. All parameters were compared among all six groups obtained from the 60 cases in chronological order. Besides, the outcomes of supine PCNL were also compared to prone PCNL. Results: Mean operative time from 60 cases of supine PCNL was 100 ± 27 minutes. The mean operative time was decreased over time, particularly after 20 cases. Significantly different mean operative times (89 ± 14 minutes vs. 126 ± 21 minutes, p < 0.001) in the groups of cases 21-60 compared to the group of 1–20 cases were observed. The total stone-free rate for supine PCNL from all cases was 68%. There was no difference regarding the reduction of hemoglobin level, stone-free rate, hospital stay, and complication rate. No major complication was found among study subjects. Supine PCNL showed similar outcome parameters compared to prone PCNL. Conclusion: The surgeon acquired the surgical competencies to perform supine PCNL after 20 cases. The supine PCNL could remove the kidney stone as effective and safe as prone PCNL.

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COMPARISON OF PERCUTANEOUS NEPHROLITOTOMY (PCNL) IN PRONE AND SUPINE POSITION: A SINGLE CENTRE EXPERIENCE REPORT

Indonesian Journal of Urology ◽

10.32421/juri.v28i1.643 ◽

2021 ◽

Vol 28 (1) ◽

pp. 39-43

Author(s):

Ferry Safriadi ◽

Dadan Ramdhan

Keyword(s):

Hospital Stay ◽

Prone Position ◽

Percutaneous Nephrolithotomy ◽

Supine Position ◽

Operating Time ◽

Transfusion Rate ◽

Major Complications ◽

Stone Free Rate ◽

The Mean ◽

Free Rate

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.

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Percutaneous-Based Management of Staghorn Calculi in Solitary Kidney: Combined Mini Percutaneous Nephrolithotomy versus Retrograde Intrarenal Surgery

Urologia Internationalis ◽

10.1159/000360708 ◽

2014 ◽

Vol 94 (1) ◽

pp. 70-73 ◽

Cited By ~ 8

Author(s):

Wen Zhong ◽

Zhijian Zhao ◽

Liang Wang ◽

Sunil Swami ◽

Guohua Zeng

Keyword(s):

Percutaneous Nephrolithotomy ◽

Operation Time ◽

Solitary Kidney ◽

Retrograde Intrarenal Surgery ◽

Staghorn Calculi ◽

Combined Use ◽

Stone Free Rate ◽

Group 2 ◽

Free Rate ◽

Group 1

Introduction: Mini percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) are well-established techniques with little morbidity. The combined use of standard PCNL and the mini-PCNL or the RIRS technique was evaluated and compared to investigate their own role in the management of staghorn calculi in solitary kidney. Materials and Methods: 23 patients received combined standard PCNL and mini-PCNL (group 1), and 22 patients received combined standard PCNL and RIRS (group 2). The treatment results and complications were evaluated and compared. Results: The mean operation time was 128.8 ± 9.1 min in group 1 and 109.8 ± 10.7 min in group 2 (p < 0.001). The decrease in hemoglobin level in group 1 was significantly higher than that in group 2 (3.5 ± 0.6 vs. 2.1 ± 0.5 g/dl, p < 0.001). The final stone-free rate was significantly higher (p = 0.038) in group 2 (90.9%) than in group 1 (65.2%). Conclusions: Combined standard PCNL and RIRS technique can extract the majority of staghorn calculi quickly by PCNL with EMS Lithoclast, and RIRS used simultaneously can reduce the need for multiple tracts and therefore reduce blood loss and potential morbidity related to multiple tracts, shorten the operation time and achieve a high stone-free rate.

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Counter-Irrigation as a Novel Technique versus the Standard Technique in Percutaneous Nephrolithotomy: A Prospective Randomized Trial

Urologia Internationalis ◽

10.1159/000518372 ◽

2021 ◽

pp. 1-7

Author(s):

Ahmed El-Sakka ◽

Abdelnaser Elgamasy ◽

Karim Sallam ◽

Mohamed G. Soliman

Keyword(s):

Blood Transfusion ◽

Hospital Stay ◽

Randomized Trial ◽

Percutaneous Nephrolithotomy ◽

Standard Technique ◽

Prospective Randomized Trial ◽

Stone Free Rate ◽

Group A ◽

Group B ◽

Free Rate

Objective: This study aimed to evaluate the efficacy of our counter-irrigation technique versus the standard technique in percutaneous nephrolithotomy (PCNL) by assessment of the stone-free rate after the procedures and its safety in terms of comparing the intraoperative time, Hb deficit, blood transfusion, length of hospital stay, auxiliary procedures, and perioperative complications with that of the standard one. Methods: This prospective randomized trial was conducted on patients with renal stone 2–3 cm in diameter without contraindications to PCNL. The patients were randomized into group A in which the counter-irrigation technique has been performed and group B who were managed by the standard technique. The preoperative characteristics including demographic data and stone parameters were compared between both groups. The primary outcome was the stone-free rate assessed by noncontrast spiral CT after 3 months. The secondary outcome included intraoperative time, Hb deficit, blood transfusion, hospital stay, auxiliary procedure required, and rate of complications. Results: Forty-eight patients were included in this study. Overall, no significant difference was observed between both groups regarding preoperative characteristics, Hb deficit, and complication rate. Operative time was significantly shorter in group B (p = 0.001). None of our patients required blood transfusion. The stone-free rates at 3 months were significantly better in group A (95% for group A and 70% for group B, p = 0.04). Conclusions: Our results indicate that our counter-irrigation technique has lower stone migration with subsequent significantly better stone-free rate versus the standard technique. We can recommend this technique as a potentially valid option for cases with large stone burden when the access to the upper calyx is feasible to minimize significant residual fragments.

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Flank Suspended Supine Position for Percutaneous Nephrolithotomy

Urologia Journal ◽

10.5301/ru.2012.9024 ◽

2012 ◽

Vol 79 (1) ◽

pp. 58-61 ◽

Cited By ~ 4

Author(s):

Pan Tie-jun ◽

Li Gong-cheng ◽

Ye Zhang-qun ◽

Wen Han-dong ◽

Shen Guo-qiu ◽

...

Keyword(s):

Percutaneous Nephrolithotomy ◽

Supine Position ◽

Renal Stone ◽

Pleural Cavity ◽

Operation Time ◽

Bleeding Rate ◽

Extracorporeal Shock Wave ◽

Stone Free Rate ◽

Positioning Method ◽

Free Rate

Aims Prone and supine positions for percutaneous nephrolithotomy are widely used but have their drawbacks. We report a new positioning method called “flank suspended supine position” (FSSP) for PCNL and describe our experience with PCNL in this position to evaluate its safety and efficacy. Methods Retrospective study of 150 cases of renal stone patients treated with PCNL in a new position called flank suspended supine position (FSSP) from June 2009 to July 2010. All patients were treated with PCNL in FSSP under epidural anesthesia. Operation time, bleeding rate, stone free rate, and complications were recorded. Results All patients tolerated FSSP. Mean operation time was 78.29±26.13 min. Initial stone-free rate was 83%. For those with residual stones (26 cases), 18 were stone-free after a second PCNL, 8 after extracorporeal shock wave lithotripsy (ESWL). Mean hospital stay was 7.63±2.39 days. No penetrating injury of the pleural cavity or injury to visceral organs was reported. Summary FSSP is an effective and safe position for PCNL in our hands and its effectiveness relative to traditional prone position needs to be determined in future randomized studies.

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The Outcomes of Minimally Invasive Percutaneous Nephrolithotomy with Different Access Sizes for the Single Renal Stone ≤25 mm: A Randomized Prospective Study

Urologia Internationalis ◽

10.1159/000516914 ◽

2021 ◽

pp. 1-6

Author(s):

Weimin Yu ◽

Yuan Ruan ◽

Zhuang Xiong ◽

Yunlong Zhang ◽

Ting Rao ◽

...

Keyword(s):

Minimally Invasive ◽

Percutaneous Nephrolithotomy ◽

Operative Time ◽

Controlled Trial ◽

Demographic Data ◽

Operation Time ◽

Stone Free Rate ◽

Significant Difference ◽

Minimally Invasive Percutaneous Nephrolithotomy ◽

Free Rate

Objectives: The aim of this study was to provide a randomized controlled trial comparing the outcomes of different access sizes used in the solo ultrasonic-guided minimally invasive percutaneous nephrolithotomy (mini-PCNL). Methods: From January 2018 to December 2019, a total of 160 cases with single renal stones of <25 mm were randomized to undergo mini-PCNLs with Fr16, Fr18, Fr20, or Fr22 accesses. All accesses were established with the axis of the target calyx as the marker for puncture location and then expanded to the desired size. Hemoglobin reduction, operative time, stone-free rate, complications, etc., were all recorded and assessed. Results: The demographic data were similar, and there were no significantly intergroup differences in stone-free rate, complications, and hospital stay time. The hemoglobin reduction was comparable and was 0.9 ± 0.6, 0.9 ± 0.7, 1.0 ± 0.5, and 1.1 ± 0.7 g/dL for the groups Fr16, Fr18, Fr20, and Fr22, respectively. The operative time was 53.4 ± 14.5, 48.5 ± 15.2, 42.8 ± 13.3, and 43.3 ± 13.1 min for the 4 groups, which decreased significantly from group Fr16 to Fr20, but there was no significant difference between Fr20 and Fr22 groups. Conclusions: The axis of target calyx is a reliable marker for establishment of percutaneous renal access under ultrasonic guidance. The surgical outcomes of different access sizes were comparable, but the operation time was significantly shortened with the increase of size. However, Fr22 was not more efficient than Fr20.

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