Modified supine (Giusti) percutaneous nephrolithotomy is noninferior to standard prone procedure for renal calculi: A single-center prospective randomized study

Abstract

Purpose: The objective is to compare operative times, safety, effectiveness, postoperative pain, and need for analgesia for percutaneous nephrolithotomy (PCNL) in the modified supine (Giusti) versus the standard prone position. Materials and methods: A prospective randomized study of 82 patients was conducted from August 2021 to August 2022 at a tertiary medical teaching hospital. The cohort was divided into modified supine and prone PCNL groups (40 and 42 patients in supine and prone). The measured variables included age, sex, body mass index, stone size, comorbidities, procedure time, stone-free rate, pain severity/Visual Analog Scale, analgesia requirement, hospital stay, and complications (modified Clavien-Dindo grading). Results: The 2 groups were comparable in mean age, male-to-female ratio, stone size, residual calculi, and postoperative fever. The mean procedure time was 72.24 versus 90.12 minutes in favor of the modified supine PCNL (P < 0.001). The absolute stone-free rate showed no significant difference (82.5% versus 80.95%; P = 0.91) in both the groups. The severity of postoperative pain according to Visual Analog Scale was 2.9 (2–5) and 5.1 (3–7) in the modified supine and prone groups (P < 0.001). Patients undergoing supine PCNL needed analgesics fewer times and in lesser dosage than the prone PCNL group (1.27 versus 3.93; P < 0.001). Hospital stay was shorter in the supine group than the prone group (2.87 versus 4.40 days; P < 0.001). No differences in septic or bleeding complications were found. Conclusion: The modified supine PCNL is safe and noninferior to prone PCNL with shorter operative time, reduced postoperative pain, lesser need for analgesia, and shorter hospital stay, with the additional benefit of minimal physiological changes during anesthesia.