Supine Percutaneous Nephrolithotomy Research Articles

Supine Percutaneous Nephrolithotomy in A High-Volume Center: First 60 Cases

Aim: To present the first 60 supine percutaneous nephrolithotomy (PCNL) surgeries performed in our clinic with regard to the results and reliability of this surgery. Material and Methods: A retrospective study carried out on 40 patients who had undergone PCNL in supine position due to the kidney stone between September 2021 and May 2022. The following parameters were studied: Demographic characteristics, stone size and HU index, operation time and postoperative complications. Results: Patient’s mean age was 46,95, the oldest one was 90 years old, and 13 of them were female. Two of the patients had solitary kidney and 15 of them had previous surgery for kidney stone. 10 patients had this surgery under spinal anesthesia. Mean stone surface area and Hounsfield Unit were 595,4 mm2 and 916.6, respectively. In 3 cases, endoscopic combined intrarenal surgery was performed. Mean operation time was 63,75 minutes and scopy time was 16.5 seconds. 27 patient had totally tubeless procedure and 30 patient had tubeless surgery. None of the patient was required to blood transfusion or any other approach related to bleeding. Only two patient had fever and needed IV antibiotics. Stone free rate was 95 % in one session. Discussion: Supine PCNL surgery is a feasible surgery with low complication rate and high stone-free rate. It is easier to switch to the supine position in clinics where this surgery is performed intensively in the prone position. It should become more widespread especially in terms of the advantages it offers compared to prone PCNL.

Outcomes of Complete Supine Percutaneous Nephrolithotomy: Comparison of Elderly and Young Patients

Abstract Purpose: Percutaneous nephrolithotomy (PCNL) in the elderly is challenging due to age-related decline in organ function and the general depletion of the physiological reserve. We aimed to compare the efficacy and safety of complete supine PCNL (csPCNL) between young and elderly patients with kidney stones. Materials and Methods: In this cross-sectional comparative study, a total of 656 patients aged 18–64 years (young group) and 83 patients aged ≥65 years (elderly group) who underwent csPCNL between April 2009 and September 2021 were studied. The two groups were compared in terms of clinical characteristics, stone-related parameters, perioperative parameters, and postoperative outcomes. Results: The mean age of elderly and young patients was 69.87 and 47.1 years, respectively. The female-to-male ratio was 1:1.21. The mean hemoglobin drop was significantly greater in the younger group (1.38 ± 1.08 vs. 1.01 ± 0.84 g/dL, P = 0.007). The stone-free rate was comparable in the two groups (96.8% vs. 91.5%), whereas hospitalization was significantly longer in the younger group (P = 0.014). There was no significant between-group difference regarding the postoperative complication rates (P = 0.36). On multivariate analysis, body mass index, stone burden, and presence of staghorn stone were identified as independent predictors of the success of the operation (P = 0.04, odds ratio [OR] = 1.091; P = 0.000, OR = 0.962; P = 0.045, OR = 0.404). None of these factors had an independent effect on the occurrence of postoperative complications (P > 0.05). Conclusion: CsPCNL in the elderly age group is an effective and safe procedure with high stone-free rates and similar complication rates compared to younger patients.

Free Flank Modified Supine Percutaneous Nephrolithotomy for Management of Primary Renal Stones

Free Flank Modified Supine Percutaneous Nephrolithotomy for Management of Primary Renal Stones

Is supine percutaneous nephrolithotomy an alternative to prone percutaneous nephrolithotomy? Our experience at a tertiary care center

Background: Majority of urologists prefer the usual prone position for percutaneous nephrolithotomy (PCNL) but due to various disadvantages of prone PCNL, several alternative positions are being used. Aims and Objectives: The aim of the study was to compare the surgical outcomes of PCNL performed using supine position with those performed in the prone position. Materials and Methods: This was a prospective and observational study. After applying inclusion criteria, 60 renal calculi patients were randomly assigned to two groups, each with 30 patients, all demographic, operative, and post-operative characteristics were recorded. Results: Out of 60 patients, 38 (63%) patients were male and 22 (37%) were female. The mean age (in years) in prone PCNL was 45.03±17 while in supine, it was 51.7±15. Forty patients had mild, 12 had moderate, and eight had gross hydronephrosis. Stone size (mm) ranged from 20 to 55 with a mean stone size of 22.5±8.8 in prone PCNL and 23.9±13.5 in supine PCNL. The mean operative time (minutes) was 65.1±27.2 in prone PCNL and 68.7±16 in supine PCNL (P=0.068). Complete stone clearance was seen in 26 (86%) patients in prone PCNL versus 25 (83%) patients in supine PCNL. Five patients in supine PCNL had Grade 1–2 complications. There were no serious complications in either group. The mean post-operative hospital stay (days) was 3.53 in prone PCNL versus 3.63 in supine PCNL, (P=0.715). Conclusion: Supine PCNL is an effective and safe procedure with similar operative time, stone-free rate, and complications to prone PCNL.

The learning curve for a single surgeon using ultrasonography to guide supine percutaneous nephrolithotomy with an alken metal telescopic dilator

Ultrasound (US) has three advantages over fluoroscopy for guiding percutaneous nephrolithotomy (PNCL): it provides an assessment of adjacent structures and real-time puncture adjustment, and is radiation free. This study aimed to define the number of procedures that should be performed to achieve competence in US-guided PCNL using an Alken metal telescopic dilator. A non-randomised retrospective study with consecutive sampling was used for the study design. A total of 50 patients above 18 years of age with the largest diameter of renal stone ≥20 mm were included. They were divided into five groups based on timing of the surgery to evaluate and visualise improvements based on primary outcomes within the groups. Line charts were used, and statistical analysis was performed to evaluate the learning curve. Most of the base characteristics between the groups were similar. Tract dilatation time decreased significantly after 20 PCNLs were performed (p < 0.001). Stone-free status markedly increased after 20 PCNLs were performed (p < 0.001). Postoperative fever (10%) and need for blood transfusion (26%) were the only complications. Basic competency was achievable after 20 PCNL procedures were performed, and further improvements in outcomes were achieved after 40 PCNLs with an acceptable rate of non-severe complications.

Factors Predicting Outcomes of Supine Percutaneous Nephrolithotomy: Large Single-Centre Experience.

Objective: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large renal calculi. The prone position has been considered the preferred position to obtain renal access. However, the supine position has recently gained popularity, which confers several potential advantages. The current study analyses the prognostic factors for successful supine PCNL procedures in a larger tertiary centre. Subjects: Prospective data were collected from all patients undergoing PCNL in the Galdako modified Valdivia position at our institution between February-2007 and September-2020. Surgical outcomes variables collected included: the rate of Endoscopic-combined intra-renal surgery (ECIRS), operative times, surgical effectiveness (no residuals <2 mm stone fragments) and complications. Results: A total of 592 patients underwent PCNL with a median age of 56 years (IQR: 42−67). The median stone size was 17 mm (IQR: 13−23). Of those, 79% of patients had an effective procedure. Stone size (p < 0.001), location (p < 0.001) and Guys-Stone Score (GSS) (p < 0.001) were associated with effectiveness. A Percutaneous nephrostomy tube was sited at the completion of the procedure in 97.3% of patients and a simultaneous double-J stent in 45.3%. Stent insertion was associated with larger stones (p < 0.001), the performance of ECIRS (p < 0.001) and higher GSS (p < 0.001). The overall complication rate was 21.7%. The main type of complication was an infection in 26.2 of the cases followed by the need for repeated nephrostogram in 12.7%. Conclusions: We demonstrate that PCNL in a high-volume centre is safe and efficacious in the Galdalko modified Valdivia position. Patients with smaller stones in the renal pelvis and a low GSS have the highest chance of a successful procedure.

Comparison Between Supine Position Versus Prone Position In Percutaneous Nephrolithotomy: A Single Centered Analysis Of 623 Cases.

The ideal urological method for treating complex, large renal calculi is Percutaneous nephrolithotomy (PCNL). Its instruments, surgical techniques, and positions have all been adjusted as a result of its ever-changing nature. In PCNL, the supine position is advantageous compared to the prone position due to its several advantages, including the absence of cardiopulmonary risks, fewer post operative complications and shorter operative time. This study was designed for comparison of PCNL in prone and supine positions. After receiving ethical and research committee approval, this retrospective review from secondary data was conducted from April 2015 to December 2021. Out of 623 patients, PCNL in prone position was performed on 258 patients and365 patients inmodifiedsupine position. The patients' demographics, stone size and location, number of tracts, operating time, hospital stay, stone clearance rate, and post-operative complications were all compared. The gender and age of the patients, the size and number of tracts, and location of the stones were all comparable (p>0.05). Operative time for prone position was 82 min ±2.49 SD VS 65 min ±2.95 SD, for modified supine position, p<0.001), hospital stay was 58 hrs. ±1.66 SD for prone VS 51 Hrs. ±1.65 SD, for modified supine position, p<0.01) and analgesia requirements for prone position was 41% VS 23% for modified supine position, p<0.001). The stone clearance rate was 87% in supine position and 89% in the prone positioning group (p=0.47). Urinary leakage from tract site was 0.38% in prone vs. 0% in supine position and temperature >99 °F was 12.4% in prone vs. 11.3% in supine position were the most common post-operative complications. Angioembolization was not observed in either group. Blood transfusions were given to 4.26% in prone position and in 3.58% of cases in supine PCNL. Percutaneous nephrolithotomy in the supine position had a short operating time, short hospital stays, and less analgesia requirements than PCNL in the prone position. In view of the above findings, supine PCNL is easy, quick to perform and having less complications rate as compare to Prone PCNL.

Does surgical position affect infective complications in percutaneous nephrolithotomy?

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.

A prospective, observational study to assess the feasibility and safety of supine percutaneous nephrolithotomy under regional anesthesia for obese patients with a body mass index ≥30.

Besides being a risk factor for urolithiasis, obesity is a challenge in the treatment of urolithiasis from the perspective of both the surgeon and the anesthetist. In this study, we tried to assess the feasibility and safety of supine percutaneous nephrolithotomy (PCNL) under regional anesthesia in obese patients with a body mass index (BMI) ≥30. This was a prospective observational study and included 51 obese patients (BMI ≥30 kg/m2) with renal stones planned for PCNL. All patients underwent supine PCNL under regional anesthesia with the standard technique. A decision for totally tubeless or a tubeless PCNL was made at the end of the procedure and the intraoperative and postoperative data were recorded. All patients underwent computed tomography (CT) imaging at 1 month after surgery to assess the stone-free status and the need for additional treatment. The mean age of the patients was 53.2 ± 8.09 years, and the mean BMI was 34.4 ± 2.369 kg/m2. The mean operative time was 73.3 ± 26.2 min, the mean hospital stay was 58.3 ± 22.1 h, and the mean postoperative Visual Analog Score (VAS) for pain was 3.8 ± 1.4. The stone-free rate was 68.6% on the follow-up CT performed after 1 month, and 31.4% of the patients had significant residual fragments which required re-treatment either by retrograde intrarenal surgery (RIRS) in 19.6% (either as primary RIRS for the residual calculi in one patient [1.9%] or as RIRS for post shock wave lithotripsy (SWL) or alkalinization failure in 9 patients), SWL in 21.6%, or urine alkalinization in 7.8%. Supine PCNL under regional anesthesia, in this subgroup of obese patients, was found to be feasible and safe with satisfactory stone-free rates and minimal postoperative pain.

Supine versus prone percutaneous nephrolithotomy: A comparison of efficacy and safety in obese patients

Objective: To compare prone and supine percutaneous nephrolithotomy (PNL) in obese patients with respect to efficacy and safety.Material and Methods: Individuals with kidney stones larger than 2 cm undergoing either prone or supine position PNL were included in the study based on the World Health Organization (WHO) classification of body mass index (BMI) ≥30 kg/m2 between January 2011 and September 2020 retrospectively. Demographic characteristics, intraoperative, postoperative data, and complications according to Modified Clavien Grading System were listed. Patients were followed for 3 months, documenting their stone-free status. Results: Out of the total 156 obese patients, 74(47.4%) underwent supine PNL (group 1), and 82 (52.6%) were prone to PNL (group 2). There was no statistically significant difference between the groups concerning hemoglobin drop, the number of pelvicalyceal access, blood transfusion, length of hospital stay, complications rates, and stone-free status (p&amp;gt;0.05). The location of pelvicalyceal access (upper, middle, lower calyces) was significantly different (18.9%, 32.4%, 42.6% in group 1, 3.2%, 19.3%, 77.5% in group 2, respectively) (p&amp;lt;0.001). Mean operative times were statistically different between the groups (97.2 ± 18.1 minutes in group 1, 119.5 ± 18.9 minutes in group 2, respectively) (p&amp;lt;0.001).Conclusion: In the prone or supine position, PNL is a safe and effective method for managing kidney stones in obese patients. Access through the upper calyx may be favored in the supine position considering to patient’s characteristics. Additionally, the supine position has the greatest advantage over the prone position due to shorter operative times.

Surgical outcomes of supine PCNL in spinal deformity patients: A tertiary care hospital experience.

Percutaneous nephrolithotomy (PCNL) is treatment of choice now a days in patients with spinal deformity with large kidney stones. Objectives of our present study to compare in which position it is better to perform and costs minimum complications after surgery. A total of 14 patients with spinal deformity having nephrolithiasis were selected randomly. No preferences for age, gender, size, location, and laterality of stone or BMI. All the patients were fit according to AUA guideline criteria for management by PCNL. Preoperative and postoperative data were collected in all operated patients. Descriptive statistics were performed as means, standard deviations, and ranges using Microsoft excel. For categorical variables percentage were used. A total of 14 patients with spinal deformity having nephrolithiasis underwent PCNL. Seven patients operated in prone position and seven patients operated in modified supine position within approximately 2 years. As compared to prone position in supine position there were reduced operative time, little or no change in Hb concentration, shorter hospital stay, little intraoperative blood loss, and higher significant stone free rate were detected. Supine PCNL in spinal deformity patients with nephrolithiasis is an alternative to the standard prone PCNL. It provides an additional benefit of large operative field performing the procedure in a single position, reduces total operating time, less anesthesia related complications, less neuromusculoskeletal injury, and reduce physical strain on operating surgeon.

Percutaneous nephrolithotomy and laparoscopic surgery efficacy and renal function outcomes for large and complex renal calculi

Abstract Background There is limited published evidence regarding the incidence of intraoperative and postoperative events and the effect of percutaneous nephrolithotomy (PCNL) in supine and prone positions and laparoscopic pyelolithotomy on kidney function in patients with large and complex calculi. Materials and methods We evaluated the surgical outcomes of 97 patients with large and complex kidney stones. The patients were divided into 3 groups: those who underwent PCNL in the prone position, PCNL in the supine position, and pyelolithotomy by laparoscopy and retroperitoneoscopy. General surgical outcomes, size of residual stones, stone-free rate, glomerular filtration rate (GFR), and split GFR obtained from Tc-99m renal dynamic scintigrams were analyzed. Results Percutaneous nephrolithotomy in the prone position was correlated with improved function of the affected kidney. In the supine PCNL group, none of the analyzed indicators demonstrated a significant difference. Dynamic nephroscintigrams revealed negative changes in terms of accumulation and secretion of the affected kidney. A slight decrease in creatinine clearance was noted. However, positive dynamics in split GFR and secretory index were seen in this group. The laparoscopic group showed positive results in all analyzed parameters. However, full assessment of the function of the affected kidney in this group was limited due to restricted use of laparoscopic pyelolithotomy for complex stones. Conclusions Percutaneous nephrolithotomy in the prone position resulted in the most favorable renal functional outcomes for patients with high-grade renal calculi, whereas a laparoscopic approach may be preferred for patients with stones of lower grades. The most significant factors that adversely affected renal function were intraoperative bleeding volume, kidney stone size and density, and body mass index.

Fluoroscopy screening time and radiation dose during complete supine percutaneous nephrolithotomy.

Fluoroscopy-guided percutaneous nephrolithotomy (PCNL) is procedure of choice for treatment of large urinary tract calculi. This study aimed to investigate the affecting factors on fluoroscopy screening time (FST) and radiation dose (RD) of patients undergoing complete supine percutaneous nephrolithotomy (csPCNL). Analytic cross-sectional study was performed on 355 patients who underwent csPCNL. The correlation between the FST and RD and patients' demographics, stone characteristics, preoperative, intraoperative and postoperative parameters were assessed. Multivariate regression analysis was used to explore various parameters which affect FST and RD. Of all 355 patients, 191 (54.65%) were male and 161 were (45.35%) female with mean age of 48.29 ± 12.38 (16-82) years. BMI was 27.61 ± 4.53 (16.61-39.00) kg/m2. The mean operative time was 45.87 ± 18.29min with mean FST of 101.72 ± 62.00s. BMI, operative time, success rate, complications, stone number, and tract number had a significant relationship with FST and RD (P < 0.05). On multivariate analysis, BMI, tract number and success rate were found to be independent predictors for FST and RD. Age, gender, operation side, GFR, target calyx, lithotripsy history, stone opacity, size and site, stone configuration and distribution, and hydronephrosis did not have any correlation with FST and RD (P > 0.05). BMI, success rate and tract number can be significant predictor for FST and RD during csPCNL. Identifying the affecting factors on FST and RD can help the surgeon to minimize the danger of radiation exposure by predicting and preoperative planning.

Supine Percutaneous Nephrolithotomy

Percutaneous nephrolithotomy (PCNL) has evolved many a fold and was originally described in supine position by Valdivia et al. In this position, the direction of the tract is posterior and thus preserves a low pressure in the renal pelvis, and thereby reduces the risk of fluid absorption and allows spontaneous clearance/washout of fragments by gravity-directed flow of fluid. Supine PCNL is feasible in most situations. It is an important tool for patients who have musculoskeletal abnormalities precluding prone positioning. It gives the surgeon a simultaneous opportunity to do flexible ureteroscopy. Mobility of the kidney may make the puncture difficult. Suctioning of the dust using the suction sheath in supine PCNL makes the procedure more effective.

Video 6 - Novel biplanar technique for renal access in supine percutaneous nephrolithotomy

Video 6 - Novel biplanar technique for renal access in supine percutaneous nephrolithotomy

Oral 31 - Modified supine percutaneous nephrolithotomy for large kidney stones: outcomes and results

Oral 31 - Modified supine percutaneous nephrolithotomy for large kidney stones: outcomes and results

Comparison between prone and supine nephrolithotomy in pediatric population: a double center experience

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.

Predictive factors for success after supine percutaneous nephrolithotomy: an analysis of 961 patients.

SUMMARYOBJECTIVE:The aim of this study was to evaluate the predictive factors for success following percutaneous nephrolithotomy in the supine position.METHODS:Patients who underwent percutaneous nephrolithotomy in the supine position from June 2011 to October 2018 were evaluated. Age, sex, body mass index, the American Society of Anesthesiologists physical status classification, hemoglobin level, number of previous surgeries, stone size, and the Guy’s Stone Score were analyzed. Success was considered if no fragments were observed on the computed tomography scan on the first postoperative day. Univariate and multivariate analyses were performed to determine significant parameters.RESULTS:We evaluated 961 patients; of them, 483 (50.2%) underwent previous stone-related surgery, and 499 (51.9%) had Guy’s Stone Score 3 or 4. The overall success rate in a single procedure was 40.7%, and complication rate was 13.7%. The univariate analysis showed that the maximum diameter of the stone (25.10±10 mm; p<0.001), previous percutaneous nephrolithotomy (OR 0.52; p<0.001), number of previous percutaneous nephrolithotomy (OR 0.15; p<0.001), the Guy’s Stone Score (OR 0.28; p<0.001), and the number of tracts (OR 0.32; p<0.001) were significant. In the multivariate analysis, the number of previous percutaneous nephrolithotomy (OR 0.54; p<0.001) and the Guy’s Stone Score (OR 0.25; p<0.001) were statically significant.CONCLUSIONS:Guy’s Stone Score and the number of previous percutaneous nephrolithotomy are predictors of success with the supine position. Complex cases and with previous percutaneous interventions may require technical improvements to achieve higher stone-free rates.

The safety of continued low dose aspirin therapy during Complete Supine Percutaneous Nephrolithotomy (csPCNL)

Using anticoagulants and antiplatelet drugs in patients with cardiovascular and medical comorbidities is prevalent. Because of hyper vascular nature of kidney, physicians tend to stop using aspirin before percutaneous nephrolithotomy (PCNL). We have shown the effects of remaining on low dose aspirin in complete supine PCNL (csPCNL). The records of 643 patients who underwent csPCNL between 2012 and 2018 were analyzed. Surgical outcomes and complications of patients who were on aspirin therapy and continued it daily (group A) were compared with those not taking aspirin (group B). Of the 643 csPCNLs, 40 (6%) were performed in patients of group A and the rest of 603 (94%) cases were in group B. The differences between the mean age of groups were statistically significant (60.08±9.45, group A and 48.66±12.32, group B) (P<0.001). Thirty-nine (97.5%) of patients in group A and 548 (90.9%) of group B were stone free by the end of the study which was not statistically significant (P=0.118). The mean operative time between groups A and B (43.20±21.37 and 44.83±16.83, respectively) was not considered significant (P=0.561). There was also no significant difference between 2 groups in any types of complications. Multivariate analysis showed that, perioperative aspirin use was not a significant predictor of transfusion, Hb drop, operative time and other complications. Remaining on aspirin does not increase the risk of bleeding, transfusionand other complications. Consequently, continuing aspirin prioperatively in csPCNL appears safe. There is no fear for continuing aspirin in csPCNL.

Posición óptima para la nefrolitotomía percutánea en el riñón en herradura: ¿prono tradicional o supino?

ObjectiveAlthough it was stated that supine percutaneous nephrolithotomy (PCNL) was associated with relatively shorter surgical times and comparable success and complication rates, there is no consensus in the current literature concerning the safety and efficacy of supine PCNL in patients with horseshoe kidneys. We aimed to compare supine and prone PCNL regarding safety and efficacy in patients with horseshoe kidneys. MethodsData of the patients with horseshoe kidneys who underwent PCNL for renal stones larger than 2cm between January 2010 and May 2021 were retrospectively reviewed. The study patients were categorized as Group1 (i.e., supine PCNL-SPCNL) and Group2 (i.e., prone PCNL-PPCNL). Both groups were compared regarding demographic, clinical, and surgical data. ResultsSixty-five patients were included. Among these patients, 31 (47.7%) were in Group1, while 34 (52.3%) were in Group2. Both groups were statistically similar in terms of demographic data, stone characteristics, perioperative parameters, and complication rates (P>.05). There was no statistical difference in terms of additional treatment rates, stone-free rates in the postoperative second-day and third-month evaluations (P>.05). Mean surgical time was significantly longer in Group2 (113±17.1minutes) than in Group1 (90.6±11.3minutes) (P=.000). ConclusionAlthough it is traditionally performed in the prone position, the supine approach is as safe and effective as the prone approach. In addition, the supine approach is associated with significantly shorter surgical times.