Percutaneous Nephrolithotomy: Opinion – Supine Position

Abstract

The issue of patient positioning for PNL has recently become a matter of discussion. Advantages and disadvantages of the traditional prone position are examined, in comparison with the pros and cons of the alternative supine positions. Once recognized that PNL has similar feasibility, efficacy, and safety from a urological point of view with both accesses, it becomes important to highlight the variety of relevant anesthetic complications that may take place in the prone position, especially during prolonged procedures. Since these events – although rare or anecdotal – often imply long-term or irreversible consequences, patients should be adequately informed that they are facing the risk of a heavy price in terms of human costs for treating a benign pathology such as urolithiasis by means of prone PNL. Therefore, considering safety from a wider point of view, in our opinion, supine PNL is preferable and advisable.