Investig Clin Urol.  2016 Jul;57(4):268-273. 10.4111/icu.2016.57.4.268.

Modified supine versus prone percutaneous nephrolithotomy: Surgical outcomes from a tertiary teaching hospital

• Jones MN
• Ranasinghe W
• Cetti R
• Newell B
• Chu K
• Harper M
• Kourambas
• McCahy P

• KMID: 2426504
• DOI: http://doi.org/10.4111/icu.2016.57.4.268

Abstract

PURPOSE
The traditional prone positioning of percutaneous nephrolithotomy (PCNL) is associated with various anesthetic and logistic difficulties. We aimed to compare the surgical outcomes of PCNLs performed using our modified supine position with those performed in the standard prone position.
MATERIALS AND METHODS
A prospective group of 236 renal units (224 patients) undergoing PCNL were included in this 2 site study: 160 were performed in the modified supine position were compared with 76 undergoing PCNL in the prone position. The outcomes of radiation dose, radiation time, stone free rate, body mass index (BMI), stone size, operative time, length of stay (LOS), in hospital and complications were compared. Chi-square and t-tests were used.
RESULTS
There were no significant differences in mean radiation time, radiation dose or stone size between the modified supine and prone groups. The supine group had a higher mean BMI (31 kg/m² vs. 28 kg/m², p=0.03), shorter mean surgical time (93 minutes vs. 123 minutes, p<0.001), shorter mean LOS (2 days vs. 3 days, p=0.005) and higher stone free rate (70% vs. 50%, p=0.005). There were no differences in septic or bleeding complications but the prone group had a higher rate of overall complications.
CONCLUSIONS
Modified supine PCNL has significantly lower operative time, shorter LOS and higher stone-free rate compared with prone in our series, while remaining a safe procedure.

Keyword

Kidney calculi; Percutaneous nephrostomy; Prone position; Supine position; Treatment outcomes

MeSH Terms

Adult
Aged
Female
Hospitals, Teaching
Humans
Kidney Calculi/diagnostic imaging/pathology/*surgery
Length of Stay/statistics & numerical data
Male
Middle Aged
Nephrolithotomy, Percutaneous/adverse effects/*methods
Operative Time
Patient Positioning/*methods
Prone Position
Prospective Studies
Radiation Dosage
Radiography
Supine Position
Tertiary Care Centers
Tomography, X-Ray Computed
Treatment Outcome

Figure

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  Fig. 1 This figure demonstrates the typical position used for our variation of the modified supine percutaneous nephrolithotomy prior to prepping and draping. This also shows the positioning of the bean bag which is utilized to position the patient for access.

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