Does surgical position affect infective complications in percutaneous nephrolithotomy?

Abstract

The downward orientation of the access sheath during supine percutaneous nephrolithotomy (PCNL) allows the faster evacuation of fluids and stone fragments. It theoretically can contribute to the reduction of the high intrarenal pressure-associated complications. We aimed to investigate whether there is a difference between prone and supine PCNL in terms of infective complications. This retrospective study includes 182 patients who underwent supine and prone PCNL due to kidney stones in our clinic between April 2020 and May 2022. Demographic (age, sex, body mass index, comorbidities), radiological (cumulative stone burden, stone density, number of stones, stone localization, stone laterality, presence of hydronephrosis), clinical (previous stone surgery, previous urinary tract) and perioperative (prone or supine position, surgery duration, hospitalization, success, non-infective and infective complications) data of all patients were evaluated. All patients were divided into two groups, the prone position group, and the supine position group. These two groups were compared in terms of pre and postoperative data above. Infective complications were observed in 16 (18%) patients in the prone position group and in 7 (7.5%) patients in the supine position group, and this difference was statistically significant (p = 0.034). Surgery duration (OR = 1.041; 95% CI 1.021-1.061; p < 0.001), number of stones (OR = 4.09; 95% CI 1.093-7.309; p = 0.036), previous urinary tract infection (OR = 6.272; 95% CI 1.936-9.317; p = 0.002) and prone position (OR = 4.511; 95% CI 1.265-7.087; p = 0.02) were found as independent risk factors for infective complications. Prone position was proved as an independent predictor of postoperative infectious events. Supine PCNL will be further adopted as the standard PCNL approach by a continuously growing proportion of endourologists.