Transition from Prone to Supine Percutaneous Nephrolithotomy: Comparative Analysis of a Single Novice Surgeon's Initial 119 Prone Cases versus Subsequent 118 Supine Cases.

Introduction: Percutaneous Nephrolithotomy (PCNL) is a procedure of choice for large renal calculi. It is a common urological procedure. PCNL can be performed in various positions. Aim: To determine the surgical outcomes in patients undergoing PCNL in supine and prone positions. Materials and Methods: A cohort study was conducted on patients with renal and upper ureteral stones who underwent PCNL in either prone or supine position between August 2019 to August 2020 at Urology Department, JSS Hospital, Mysuru. Supine PCNL was done in the flank Free Oblique Supine Modified Lithotomy (FOSML) position. All the procedures were performed under fluoroscopy guidance. Surgical outcomes including operative time, length of hospital stay, Stone Free Rate (SFR), radiation dose, and postoperative complications were evaluated. The collected data was tabulated and frequency (n) and percentage (%) analysis was performed. The Chi-square test was used to find the level of significance. Results: A total of 70 patients were included in the study and out of which 35 patients were in the supine (46.37±14.73 years, 28 males and 7 females) and 35 patients (47.54±12.45 years, 23 males and 12 females) were in the prone PCNL groups. Statistically significant difference was observed in the mean operating time in the supine and prone PCNL groups (81.43 vs 127.71 minutes; p-value=0.001), with a higher stone-free rate (94.29% vs 91.43%; p-value=0.643) observed in the supine PCNL group. One patient in supine group had postoperative sepsis and one patient in prone group had bleeding requiring transfusion. The Visual Analog Scale (VAS) score in supine PCNL was (5.08±0.32) less than in prone group (8.03±0.40) (p-value <0.001). Conclusion: PCNL in the supine position compared with the prone position demonstrates significantly lower operative time with similar SFR and lower VAS score.

Renal calculus disease is an age old disease of human being. PCNL (Percutaneous nephrolithotomy) stands as a gold standard treatment for large renal calculus which is traditionally being done in prone position. To evaluate the safety and efficacy of supine PCNL versus prone PCNL comparing intraoperative time, requirement of relook PCNL, post op hemoglobin drop, post operative hospital stay, post operative complication, SFR ( stone free rate). It is a prospective study done in Urology department in a tertiary care center in Eastern India between October 2017 and October 2018. A total of 84 patients with lower calyceal renal stones underwent PCNL, 42 of them in supine and 42 in prone position. Lower calyceal stone, size measuring 1 to 2 cm were included in the study. The mean intra operative time was 91.76 min in supine group and 85.43 min in prone group with a p value of 0.115. The mean hemoglobin drop was 1.11 g/dl and 1.18 g/dl in supine and prone position, respectively (p value 0.75). The mean post operative hospital stay was 4.1 and 3.86 days in supine and prone group (p value 0.58), respectively. Two patients in each group require relook PCNL. Stone free rate at 1 month was 95.23% and 90.47% (p value 0.9), respectively in case of supine and prone group. Supine PCNL is feasible, comparable to prone PCNL in respect to operative parameters with relatively higher stone free rate though statistically insignificant.

Percutaneous nephrolithotomy (PCNL) could be performed in both prone and supine positions. Each position has its own advantages and disadvantages. "Learning curve" is a graph that represents progress of a skill against the time needed to master the technique. We hypothesized that supine PCNL might have a shorter learning curve by novice urologists compared to prone PCNL based on the findings of previous studies assessing the learning curve of both techniques. The aim of this study is to assess the learning curve of prone and supine PCNL among novice urologists to detect which is easier for the beginners. One hundred and fifty patients undergoing PCNL for renal stones were included and divided into two groups; Group A included 75 patients undergoing supine PCNL and Group B included 75 patients undergoing prone PCNL. Subsequently, each group was subdivided into three subgroups of 25 patients to allow the evaluation of the learning curve of the two novice surgeons as regards: operative time, fluoroscopy time, stone free rate, and complications. The mean operative time in group A decreased from of 111.8±13.91 minutes to 84.2±15.86 minutes, and thereafter, decreased to 78.4±12.97 minutes in the three consecutive subgroups. Similarly, in group B, the mean operative time decreased from 122±23.76 minutes to 110.2±17.05 minutes, and thereafter, further decreased to 82±15.34 minutes. The operative time plateau was reached after 25 and 50 cases in groups A and B, respectively. The overall stone free rate, and complications were comparable in both groups. Both supine and prone PCNL are safe and effective; however, supine PCNL may be associated with significantly shorter learning curve.

Objective:Urological infection is a significant complication following percutaneous nephrolithotomy (PCNL), which can be performed in supine or prone positions, but its impact on infection rates remains debated. This study compares postoperative urological infection rates between supine and prone PCNL and identifies associated risk factors.Methods:A retrospective study was conducted on 290 patients who underwent PCNL between January 2014 and August 2023 in the Thammasat University Hospital. Patients were allocated into 2 groups in a 1 : 2 ratio, with 87 patients in the supine group and 203 patients in the prone group. Statistical analysis included t-tests, Mann–Whitney U tests, Fisher’s exact test, and logistic regression models.Results:Postoperative infection rates were significantly lower in the supine group, including fever (33.3% vs. 62.1%, P < .001), UTI (11.5% vs. 32.5%, P < .001), and sepsis (6.9% vs. 17.2%, P = .021). Multivariable analysis identified positive preoperative urine culture (RR 4.41, P < .001) and prone positioning (RR 4.38, P = 0.004) as independent risk factors. The operative time was significantly shorter in the supine group (103.9 ± 42.6 vs. 116.3 ± 38.9 min, P = .016). Stone-free rates and blood loss were comparable, whereas pleural complications were higher in the prone group (6.4% vs. 0%, P = .016).Conclusion:Supine PCNL is associated with significantly lower postoperative infection rates, shorter operative times, and reduced pleural complications compared to the prone position. These findings support supine PCNL as a safer and equally effective alternative management for renal calculi.

Stone disease in the pediatric age is an increasing issue. Percutaneous Nephrolithotomy (PNL) can be used for larger and complex stones. As in adults it can be performed in the supine or prone position. We retrospectively reviewed two centers' experience in prone and supine PNL in children to analyze its results and complications. 33 patients underwent prone and 19 supine procedures. Patients in the prone group were younger than in the supine, while no significant differences were found in stone burden, access size, operative time or complications. Complications were: 8 and 4 Clavien 1 for the prone and supine group, respectively, one case of urosepsis (4b) in the prone and 2 cases of Clavien 3 in the supine group (double J stent placement for renal colic and ureteroscopy for steinstrasse). Tubeless procedures and mean nephrostomy time were in favor of the supine group, whereas fluoroscopy time and ureteral drainage stay were in support of the prone group. Stone free rate was better in the supine group (83.3 vs 66.6%), possibly reflecting the capability to perform a combined approach in 12 patients (allowing to reach all the calyx with simultaneous anterograde and retrograde access) or younger age in the prone group (13 vs 2 patients ≤5years), with no differences in stone burden. Supine approach seems to guarantee higher stone-free rates. Larger series are necessary to determine what the best technique is in terms of X-ray exposure, operative time and complications.

Background Percutaneous nephrolithotomy (PCNL) performed in the prone position is known for its high success rate and low morbidity. However, the supine position offers notable advantages, leading to a debate over the preferred position for PCNL. This study aimed to compare the efficacy and safety profiles of PCNL to determine if one position is superior to the other.MethodsA prospective comparative study was conducted in Kathmandu Medical College and Teaching Hospital, Kathmandu, involving 60 patients over a six months period from January, 2024 to July, 2024, who underwent PCNL. All patients were divided into 2 groups, in which group 1 underwent PCNL in supine position and group 2 underwent PCNL in prone position. We have evaluated the two approaches in terms of operative time, stone clearance rate, drop in hemoglobin, hospital stay and complications.ResultsThe stone free rate was slightly higher in supine group (86%) compared to the prone group (82%), though this difference was not statistically significant (p-value 0.12). Mean operative time was significantly shorter for supine PCNL (74.63±12.42 min) than prone PCNL (90.02±12.67 min) (p-value &lt;0.0001). Overall complication rates were 15% in supine group and 25% in prone group, with no statistically significant difference (p-value = 0.51). Patients in the prone PCNL group had a significantly longer hospital stay (3.20±0.92 days) compared to the supine group (2.40±0.74 days) (p-value &lt;0.001).Conclusions Supine PCNL is as effective and safe as prone PCNL, while having significantly shorter operative time.

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 &lt; 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 &lt; 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 &lt; 0.001). Hospital stay was shorter in the supine group than the prone group (2.87 versus 4.40 days; P &lt; 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.

Background: Renal stones larger than 2 cm in the upper pelvical system are usually managed with Percutaneous Nephro-lithotomy (PCNL) operation, but there are unclear as to which position should be used. In our study, we aimed to compare the preoperative-peroperative and postoperative data of patients who underwent PCNL with isolated renal upper pole access in supine and prone position. Materials and Methods: The study included 20 Supine PCNL and 45 Prone PCNL cases who underwent isolated renal upper pole access for renal calculi. Age, gender, body mass index (BMI) were evaluated from demographic data. Radiological findings such as stone-skin distance, stone density, stone size and volume were recorded. Total operation time, access time and fluoroscopy time were recorded from peroperative data. In the postoperative period, the duration of hospital stay and complications according to Clavien Dindo classification were recorded. Non-contrast computed tomography was performed at the 1st postoperative month and the stone-free status of the patients was evaluated. Results: There was no statistical difference in demographic data in terms of age, gender, BMI, ASA scores in both groups. The total operation time was 75.95±28.7 min in supine PCNL group and 92.48±23.4 min in prone PCNL group (p&amp;lt;0.001). Access time was 11.6±5.12 min in supine PCNL group and 9.2±3.7 min in prone PCNL group (p&amp;lt;0.001). Fluoroscopy time was 3.6±1.2 min in the supine PCNL group and 2.5±1.1 min in the prone PCNL group and was statistically longer (p&amp;lt;0.001). There was no difference in complications between the groups. Grade&amp;gt;2 complications according to Clavien Dindo classification were more frequent in supine PCNL patients (p:0.03). Stone-free status was 70% in supine PCNL patients and 77.7% in prone PCNL patients and was higher in the prone PCNL group (p:0.01). Conclusions: In patients undergoing PCNL for isolated upper pol stone, the operation time is longer when prone PCNL is performed, but higher stone-free rates are obtained in these patients. Grade &amp;gt;2 complications are less common in prone PCNL for renal upper pole calculi.

Background and Objectives: Percutaneous nephrolithotomy (PCNL) is a current treatment method with high success rates and low complication rates in treating large kidney stones. It can be conducted in different positions, especially supine and prone positions. PCNL in the supine position is becoming increasingly common due to its advantages, such as simultaneous retrograde intervention and better anesthesia management. This study aimed to assess how the choice of position impacts the PCNL learning curve. Materials and Methods: The results of the first 50 consecutive PCNL cases performed by two separate chief residents as primary surgeons in supine and prone positions in a reference center for stone treatment between August 2021 and January 2023 were evaluated. The two groups' demographic and clinical data, stone-free rates, operation times, and fluoroscopy times were compared. Results: While the mean operation time was 94.6 ± 9.8 min in the supine PCNL group, it was 129.9 ± 20.3 min in the prone PCNL group (p < 0.001). Median fluoroscopy times in the supine PCNL and prone PCNL groups were 31 (10-89) seconds and 48 (23-156) seconds, respectively (p = 0.001). During the operation, the plateau was reached after the 10th case in the supine PCNL group, while it was reached after the 40th case in the prone PCNL group. Conclusions: For surgeons who are novices in performing PCNL, supine PCNL may offer both better results and a faster learning curve. Prospective and randomized studies can provide more robust conclusions on this subject.

PurposeThe 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 MethodsA 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.ResultsThere 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.ConclusionsModified 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.

Endoscopic combined intrarenal surgery versus percutaneuos nephrolithotomy for complex pediatric stone disease: A comparative analysis of efficacy and safety

Introduction: Percutaneous Nephrolithotomy (PCNL) is the preferred method for treating large or complex renal calculi. Despite positive results and apparent benefits over the prone position, there are few randomised trials comparing the supine and prone positions. Aim: To evaluate the effectiveness of PCNL in prone and supine positions in terms of operative time, stone-free rate, hospital stay, postoperative complications, and the level of haemoglobin drop. Materials and Methods: The study was conducted from December 2020 to December 2022, at the Department of Urology, Mamata Medical College in Khammam, Telangana, India. Patients with renal stones diagnosed by Non-Contrast Computed Tomography (NCCT) Kidney Ureter Bladder (KUB) and meeting the inclusion criteria were enrolled. Patient demographic data, operative time, stone-free rate, haemoglobin level drop, postoperative fever, and hospital stay in prone and supine positions were recorded. Statistical tests like chi-square or Fisher-exact test were used to compare proportions, and the student t-test was used to compare means. Results: The overall operative time was 79.50 minutes in the prone group and 66.78 minutes in the supine group (p=0.0213). The average hospital stay was 2.68 days in the prone group and 2.72 days in the supine group (p=0.2432). Fall in haemoglobin levels, size of stones extracted, and stone-free rate at three months between the two groups (p&gt;0.05) showed insignificant relation. Furthermore, there was no significant difference in complications between the two groups (p&gt;0.05). Conclusion: PCNL performed with the patient in the supine position requires significantly less time during surgery. There was no significant difference in terms of stone-free rate, hospital stay, fall in haemoglobin levels, and complications between the supine and prone groups.

BackgroundThe best way in the management of calyceal stone by percutaneous nephrolithotomy (PCNL) is to go directly into the desired calyx. However, in upper calyx, this direct entry may be associated with undesired complications, and through lower calyx is limited in prone PCNL. Recently, there is another option about reaching it through the lower calyx in supine position with more accessibility and better manipulation. This study aimed to evaluate the management of the upper calyceal stone by PCNL through lower calyx access in prone versus supine position.MethodsA total of 38 patients with upper calyceal stone (≥ 2 cm) were randomly divided into two groups; the first group included 18 patients managed by PCNL in the prone position, and the second group included 20 patients managed in supine position. All data of both procedures were collected and statistically analyzed to compare between both groups.ResultsThere is no statistically significant difference between groups as regards demographic and stone characters. The angle between the access to the lower calyx and access of the upper calyx was significantly wider in the supine group versus prone group (130.2° ± 23.46° vs. 89.67° ± 14.56°, respectively). The mean operative and fluoroscopy time was significantly longer in the prone group. There is no significant difference in intraoperative or postoperative morbidity. The stone-free rate was significantly higher in the supine group than the prone group (85% vs 38.9%, respectively). Also stone approachability was higher in the supine group than prone group (95% vs. 66.7%, respectively).ConclusionManagement of upper calyceal stone by PCNL through the lower calyx is safe, but it is more effective in the supine position than in prone position.

Objective: This study was designed to compare the efficacy and safety of the supine and prone positions in percutaneous nephrolithotomies (PCNLs) used for the treatment of kidney stones in Indonesian patients.&#x0D; Methods: This was a single-blinded randomized controlled trial of those patients undergoing PCNLs from February to May of 2018. There were 19 subjects in the supine group and 19 in the prone group for a total of 38 study subjects. The study outcomes that were compared included the operative time, hospital length of stay (LOS), stone-free rate, blood loss, conversion to open surgery, blood transfusion, and complications. These outcomes were evaluated using the Student’s t test and the chi-squared test.&#x0D; Results: There were no significant differences in the patient demographics or stone locations between the two groups. Additionally, the medians of the operative times, LOSs, blood losses, and blood transfusions were not statistically different. There was a higher stone-free rate in the supine group than in the prone group (70.0% vs. 47.4%, respectively, p = 0.151). More subjects were transfused in the supine group (30.0%) than in the prone group (15.8%), but this difference was not statistically significant (p = 0.292). The only complications were infundibular lacerations, which occurred in 20% of the subjects in the supine group and 15.8% of the subjects in the prone group (p = 0.732).&#x0D; Conclusion: This study showed that the supine and prone positions for PCNLs had similar efficacy and safety outcomes.

Background: Percutaneous nephrolithotomy (PCNL) is the preferred treatment of choice for renal calculi. PCNL has evolved remarkably since the eighties when it was first described. PCNL is the treatment of choice for renal stones ≥2 cm. Aims and Objectives: Our aim is to observe the various surgical outcomes of different types of PCNL. Materials and Methods: It is an observational study conducted in our institute a total of 160 pts of renal stone disease who presented to the outpatient department were included in the study. All patients underwent PCNL either in supine or prone position. The parameters such as stone free rate, body mass index (BMI), stone size, operative time, length of stay (LOS), in hospital, and complications were observed. Results: There were no significant differences in stone size between supine and prone PCNL patients. The supine group had a higher mean BMI, shorter mean surgical time, shorter mean LOS, and higher stone free rate. Prone PCNL patients had a higher rate of overall complications. Conclusion: PCNL is one of the best modalities for renal stones management, with supine and modified supine PCNL demonstrating better results in obese patients, and may be considered by all surgeons performing PCNLs.