What is one step ahead in percutaneous nephrolithotomy - Prone or supine? A review | [Rawal Medical Journal • 2024]

Author(s):

1. Sarmad Imtiaz: Department of Urology, Pakistan Kidney and Liver Institute and Research Center,Lahore,Pakistan

2. Nadeem bin Nusrat: Department of Urology, Pakistan Kidney and Liver Institute and Research Center,Lahore,Pakistan

3. Assad ur Rehman: Department of Urology, Pakistan Kidney and Liver Institute and Research Center,Lahore,Pakistan

4. Nauman Zafar: Department of Urology, Pakistan Kidney and Liver Institute and Research Center,Lahore,Pakistan

5. Shujah Muhammad: Department of Urology, Pakistan Kidney and Liver Institute and Research Center,Lahore,Pakistan

6. Saira Imtiaz: Department of Urology, Pakistan Kidney and Liver Institute and Research Center,Lahore,Pakistan

Abstract:

Percutaneous nephrolithotomy (PCNL) is an adopted procedure for the treatment of urolithiasis. The optimal position for renal access during PCNL remains a subject of ongoing debate and is commonly performed in the prone position, as it provides access to the collecting system. The supine position has a low impact on circulation and the pulmonary system. This makes it helpful to monitor and in turn, may reduce the dose of anesthetics and is quite useful in pediatric, geriatric, obese/overweight, and spinal deformity patients, and those who are debilitated. Our comprehensive review, covering literature from 2012 to 2023, scrutinized systematic reviews, meta-analyses, and prospective and retrospective cohort studies. The technique's two positions were compared concerning mean hospital stay, complication rates, operating time, analgesic requirements, and patient characteristics such as comorbidity status or mean BMI. We found no difference in terms of stone-free rates, radiation exposure, or procedural duration. Whereas patients with elevated mean BMI, requiring less analgesia, operating time, and hospital stay may benefit from the supine position. Supine takes an edge on patients with comorbidities, exhibiting a lower incidence of postoperative fever and reduced need for blood transfusions. Patient-specific factors must be considered while selecting the optimal renal access position.

Page(s): 1-5

DOI: DOI not available

Published: Journal: Rawal Medical Journal, Volume: 49, Issue: 4, Year: 2024

Keywords:

Percutaneous nephrolithotomy , Stone free rate , Complication rate , supine , prone

References:

[1] Barone B,Crocetto F,Vitale R,Di Domenico D,Caputo V,Romano F .2020 .Retrograde intra renal surgery versus percutaneous nephrolithotomy for renal stones >2 cm. A systematic review and meta-analysis. Minerva Urol Nefrol, 72 : 441-50.

[2] Wang Z,Feng D,Cao D,Zhang Y,Wei W. .2021 .Comparison of safety and efficacy between single-tract and multipletract percutaneous nephrolithotomy treatment of complex renal calculi: a systematic review and meta-analysis. Minerva Urol Nephrol, 73 : 731-8.

[3] Choong S,DE LA Rosette J,Denstedt J,Zeng G,Sarica K,Mazzon G .2022 .Classification and standardized reporting of percutaneous nephrolithotomy (PCNL): International Alliance of Urolithiasis (IAU) Consensus Statements. Minerva Urol Nephrol, 74 : 110-8.

[4] Kallidonis P,Vagionis A,Lattarulo M,Adamou C,Tsaturyan A,Liourdi D .2021 .non-papillary percutaneous nephrolithotomy for treatment of staghorn stones. Minerva Urol Nephrol, 73 : 649-54.

[5] Sofer M,Giusti G,Proietti S,Mintz I,Kabha M,Matzkin H .2016 .Upper Calyx Approachability through a Lower Calyx Access for Prone Versus Supine Percutaneous Nephrolithotomy. J Urol, 195 : 377-82.

[6] Cracco CM,Alken P,Scoffone CM .2016 .Positioning for percutaneous nephrolithotomy. Curr Opin Urol, 26 : 81-7.

[7] Karaolides T,Moraitis K,Bach C,Masood J,Buchholz N. .2012 .Positions for percutaneous nephrolithotomy: Thirty-five years of evolution. Arab J Urol, 10 : 307-16.

[8] Nilsson UG .2013 .Intraoperative positioning of patients under general anesthesia and the risk of postoperative pain and pressure ulcers. J Perianesth Nurs, 28 : 137-43.

[9] Burlingame BL .2017 .Guideline Implementation: positioning the Patient. AORN J, 106 : 227-37.

[10] Deveneau NE,Forbis C,Lipetskaia L,Kinman CL,Agrawal A,Herring NR .2017 .The Effect of Lithotomy Position on Nerve Stretch: A Cadaveric Study. Female Pelvic Med Reconstr Surg, 23 : 457-61.

[11] Kwee MM,Ho YH,Rozen WM .2015 .The prone position during surgery and its complications: a systematic review and evidence-based guidelines. Int Surg, 100 : 292-303.

[12] Lin S,Hey HW,Lau ET,Tan KA,Thambiah JS,Lau LL .2017 .Prevalence and Predictors of Pressure Injuries from Spine Surgery in the Prone Position: Do Body Morphological Changes During Deformity Correction Increase the Risks? Spine. , 42 : 1730-6.

[13] Sofer M,Giusti G,Proietti S,Mintz I,Kabha M,Matzkin H .2016 .Upper calyx approachability through a lower calyx access for prone versus supine percutaneous nephrolithotomy. J Urol, 195 : 377-82.

[14] Siev M,Motamedinia P,Leavitt D,Fakhoury M,Barcohana K,Hoenig D .2015 .Does peak inspiratory pressure increase in the prone position? An analysis related to body mass index. J Urol, 194 : 1302-7.

[15] Heng L,Wang MY,Sun HL,Zhu SS .2016 .Awake nasotracheal fiberoptic intubation and self-positioning followed by anesthesia induction in prone patients: A pilot observational study. Medicine, 95 : e4440.

[16] Tsaturyan A,Vrettos T,Ballesta B,Liourdi D,Lattarulo M,Liatsikos E .2022 .Position-related anesthesiologic considerations and surgical outcomes of prone percutaneous nephrolithotomy: a review of the current literature. Min Urol Nephrol, 74 : 695-702.

[17] Patodia M,Sinha RJ,Singh S,Singh V .2017 .Management of renal caliceal diverticular stones: A decade of experience. Urol Ann, 9 : 145-9.

[18] Mak DK,Smith Y,Buchholz N,El-Husseiny T .2016 .What is better in percutaneous nephrolithotomy - Prone or supine? A systematic review. Arab J Urol, 14 : 101-7.

[19] Chung JW,Ha H,Park DJ,Ha YS,Lee JN,Chun SY .2021 .Efficacy and safety of modified tract dilation technique using simultaneous pulling of proximal and distal ends of a guidewire for percutaneous nephrolithotomy in modified supine position. Invest Clin Urol, 62 : 186-94.

[20] Mulay A,Mane D,Mhaske S,Shah AS,Krishnappa D,Sabale V .2022 .Supine versus prone percutaneous nephrolithotomy for renal calculi: Our experience. Curr Urol, 16 : 25-9.

[21] Jamil MN,Haq FU,Islam EU,Shaheen R .2022 .Comparison Between Supine Position Versus Prone Position in Percutaneous Nephrolithotomy: A Single Centered Analysis Of 623 Cases. J Ayub Med Coll Abbottabad, 34 : 1003-7.

[22] Kucukyangoz M,Gucuk A .2023 .Which position is more advantageous for percutaneous nephrolithotomy: supine or prone?. Urolithiasis, 51 : 102-7.

[23] Jones MN,Ranasinghe W,Cetti R,Newell B,Chu K,Harper M .2016 .Modified supine versus prone percutaneous nephrolithotomy: Surgical outcomes from a tertiary teaching hospital. Invest Clin Urol, 57 : 268-73.

[24] Kannan D,Quadri M,Sekaran PG,Paul R,Panneerselvam A,Jain N. Supine,Versus Prone Percutaneous Nephrolithotomy (PCNL): A Single Surgeon's Experience N. Supine .2023 .. Cureus, 15 : e41944.

Citations

Downloads

Views