Editorial Comment

Abstract

One of the more contentious issues in the world of percutaneous nephrolithotomy (PNL) during the past few years has been supine vs prone positioning. Each approach has its relative advantages and disadvantages, many of which are enumerated by the authors 1 Proietti S. Sortino G. Antonella G. Single-session supine bilateral percutaneous nephrolithotomy. Urology. 2015; 85: 304-310 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar in the present article. This study 1 Proietti S. Sortino G. Antonella G. Single-session supine bilateral percutaneous nephrolithotomy. Urology. 2015; 85: 304-310 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar will not serve to settle this debate and declare a victor. What it does do, although, is introduce the concept of performing bilateral PNL in the same setting through a supine approach. In the authors' 1 Proietti S. Sortino G. Antonella G. Single-session supine bilateral percutaneous nephrolithotomy. Urology. 2015; 85: 304-310 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar experience, they undertook this procedure in a series of patients and claim excellent results. Although the series is small, the results do objectively suggest a relative safety of this approach. However, the usual caveats to such a series apply as follows: patient selection, surgeon experience, and institutional volume. Nonetheless, for surgeons who do routinely perform supine PNL, the same session bilateral procedure may be considered for select patients. I do not believe that this approach offers meaningful advantages over a similar procedure performed in the prone position but certainly merits consideration for those facile in the supine protocol. Single-session Supine Bilateral Percutaneous NephrolithotomyUrologyVol. 85Issue 2PreviewTo evaluate the effectiveness and safety of supine bilateral percutaneous nephrolithotomy (BPCNL) performed in the same session in patients affected with bilateral renal calculi. Full-Text PDF ReplyUrologyVol. 85Issue 2PreviewIn 1976, Fernstrom and Johansson1 revolutionized the surgical approach to urolithiasis by introducing percutaneous nephrolithotomy (PCNL) in the prone position. That position was considered the only possible way because, at that time, pioneers of endourology estimated that there was a high risk of puncturing the colon. Since then, this surgical approach has continued to evolve to improve the stone-free rate while reducing the invasiveness and morbidity of the procedure. Already in 1990, Valdivia Uria was able to demonstrate that this risk was overestimated, reporting encouraging results of the supine PCNL2 starting from the concept that a retrorenal colon is present only in 1.9% of the cases in the supine position and up to 10% in the prone. Full-Text PDF