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Current Urology Reports

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01-04-2017 | Endourology (P Mucksavage, Section Editor)

Prone Versus Supine Percutaneous Nephrolithotomy: What Is Your Position?

Authors: Roshan M. Patel, Zhamshid Okhunov, Ralph V. Clayman, Jaime Landman

Published in: Current Urology Reports | Issue 4/2017

Abstract

Purpose of Review

Percutaneous nephrolithotomy (PCNL) is the gold standard surgical procedure for treating large, complex renal stones. Due to its challenging nature, PCNL has undergone many modifications in surgical technique, instruments, and also in patient positioning. Since the first inception of PCNL, prone position has been traditionally used. However, alternative positions have been proposed and assessed over the years. This is a comprehensive review on the latest developments related to positioning in the practice of PCNL.

Recent Findings

The prone position and its modifications are the most widely used positions for PCNL, but with the introduction of various supine positions, the optimal position has been up for debate. Recent meta-analysis has shown a superior stone-free rate in the prone position and comparable complication rates to the supine position. The advantage of ease of access to the urethra for simultaneous retrograde techniques in the supine position is also possible with modifications in the prone position such as the split-leg technique.

Summary

Modern-day PCNL has transformed from an operation traditionally undertaken in the prone position to a procedure in which a prone or supine position may be employed; however, published data have not shown significant superiority of either approach.

•• Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, et al. Surgical management of stones: American Urological Association/Endourological Society Guideline, PART II. J Urol. 2016;196(4):1161–9. doi:10.1016/j.juro.2016.05.091. Recent American Urological Association guidline on the surgical management of kidney stones.CrossRefPubMed

Fernstrom I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol. 1976;10(3):257–9.PubMed

Valdivia Uria JG, Lachares Santamaria E, Villarroya Rodriguez S, Taberner Llop J, Abril Baquero G, Aranda Lassa JM. Percutaneous nephrolithectomy: simplified technic (preliminary report). Arch Esp Urol. 1987;40(3):177–80.PubMed

• Al-Dessoukey AA, Moussa AS, Abdelbary AM, Zayed A, Abdallah R, Elderwy AA, et al. Percutaneous nephrolithotomy in the oblique supine lithotomy position and prone position: a comparative study. J Endourol. 2014;28(9):1058–63. doi:10.1089/end.2014.0078. Prospective randomized study comparing supine versus prone PCNL.CrossRefPubMed

Arrabal-Martin M, Arrabal-Polo MA, Lopez-Leon V, Merino-Salas S, Palao-Yago F, Camara-Ortega M, et al. The oblique supine decubitus position: technical description and comparison of results with the prone decubitus and dorsal supine decubitus positions. Urol Res. 2012;40(5):587–92. doi:10.1007/s00240-012-0471-5.CrossRefPubMed

• Astroza G, Lipkin M, Neisius A, Preminger G, De Sio M, Sodha H, et al. Effect of supine vs prone position on outcomes of percutaneous nephrolithotomy in staghorn calculi: results from the Clinical Research Office of the Endourology Society Study. Urology. 2013;82(6):1240–4. doi:10.1016/j.urology.2013.06.068. Evaluaiton of the data from the CROES database on the effect of body position during PCNL.CrossRefPubMed

Basiri A, Mirjalili MA, Kardoust Parizi M, Moosa Nejad NA. Supplementary X-ray for ultrasound-guided percutaneous nephrolithotomy in supine position versus standard technique: a randomized controlled trial. Urol Int. 2013;90(4):399–404. doi:10.1159/000345796.CrossRefPubMed

De Sio M, Autorino R, Quarto G, Calabro F, Damiano R, Giugliano F, et al. Modified supine versus prone position in percutaneous nephrolithotomy for renal stones treatable with a single percutaneous access: a prospective randomized trial. Eur Urol. 2008;54(1):196–202. doi:10.1016/j.eururo.2008.01.067.CrossRefPubMed

Falahatkar S, Moghaddam AA, Salehi M, Nikpour S, Esmaili F, Khaki N. Complete supine percutaneous nephrolithotripsy comparison with the prone standard technique. J Endourol. 2008;22(11):2513–7. doi:10.1089/end.2008.0463.CrossRefPubMed

10.

Karami H, Mohammadi R, Lotfi B. A study on comparative outcomes of percutaneous nephrolithotomy in prone, supine, and flank positions. World J Urol. 2013;31(5):1225–30. doi:10.1007/s00345-012-0889-y.CrossRefPubMed

11.•

Mazzucchi E, Vicentini FC, Marchini GS, Danilovic A, Brito AH, Srougi M. Percutaneous nephrolithotomy in obese patients: comparison between the prone and total supine position. J Endourol. 2012;26(11):1437–42. doi:10.1089/end.2012.0257. Body mass index considerations when considering prone versus supine PCNL.CrossRefPubMed

12.

McCahy P, Rzetelski-West K, Gleeson J. Complete stone clearance using a modified supine position: initial experience and comparison with prone percutaneous nephrolithotomy. J Endourol. 2013;27(6):705–9. doi:10.1089/end.2012.0650.CrossRefPubMed

13.

Sanguedolce F, Breda A, Millan F, Brehmer M, Knoll T, Liatsikos E, et al. Lower pole stones: prone PCNL versus supine PCNL in the International Cooperation in Endourology (ICE) group experience. World J Urol. 2013;31(6):1575–80. doi:10.1007/s00345-012-0941-y.CrossRefPubMed

14.

Shoma AM, Eraky I, El-Kenawy MR, El-Kappany HA. Percutaneous nephrolithotomy in the supine position: technical aspects and functional outcome compared with the prone technique. Urology. 2002;60(3):388–92.CrossRefPubMed

15.

Sofer M, Giusti G, Proietti S, Mintz I, Kabha M, Matzkin H, et al. Upper calyx approachability through a lower calyx access for prone versus supine percutaneous nephrolithotomy. J Urol. 2016;195(2):377–82. doi:10.1016/j.juro.2015.07.101.CrossRefPubMed

16.

Walick KS, Kragh Jr JE, Ward JA, Crawford JJ. Changes in intraocular pressure due to surgical positioning: studying potential risk for postoperative vision loss. Spine (Phila Pa 1976). 2007;32(23):2591–5. doi:10.1097/BRS.0b013e318158cc23.CrossRef

17.

Wang Y, Hou Y, Jiang F, Wang Y, Wang C. Percutaneous nephrolithotomy for staghorn stones in patients with solitary kidney in prone position or in completely supine position: a single-center experience. Int Braz J Urol. 2012;38(6):788–94.CrossRefPubMed

18.

Wang Y, Wang Y, Yao Y, Xu N, Zhang H, Chen Q, et al. Prone versus modified supine position in percutaneous nephrolithotomy: a prospective randomized study. Int J Med Sci. 2013;10(11):1518–23. doi:10.7150/ijms.6305.CrossRefPubMedPubMedCentral

19.

Zhan HL, Li ZC, Zhou XF, Yang F, Huang JF, Lu MH. Supine lithotomy versus prone position in minimally invasive percutaneous nephrolithotomy for upper urinary tract calculi. Urol Int. 2013;91(3):320–5. doi:10.1159/000351337.CrossRefPubMed

20.

Valdivia JG, Scarpa RM, Duvdevani M, Gross AJ, Nadler RB, Nutahara K, et al. Supine versus prone position during percutaneous nephrolithotomy: a report from the clinical research office of the endourological society percutaneous nephrolithotomy global study. J Endourol. 2011;25(10):1619–25. doi:10.1089/end.2011.0110.CrossRefPubMed

21.

Schulman CC, SpringerLink (Online service). Advances in diagnostic urology. Springer, Berlin Heidelberg: Berlin, Heidelberg; 1981.CrossRef

22.

Goodwin WE, Casey WC, Woolf W. Percutaneous trocar (needle) nephrostomy in hydronephrosis. J Am Med Assoc. 1955;157(11):891–4.CrossRefPubMed

23.

Casey WC, Goodwin WE. Percutaneous antegrade pyelography and hydronephrosis; direct, intrapelvic injection of urographic contrast material to secure a pyeloureterogram after percutaneous needle puncture and aspiration of hydronephrosis. J Urol. 1955;74(1):164–73.PubMed

24.

Smith AD, Lange PH, Miller RP, Reinke DB. Introduction of the Gibbons ureteral stent facilitated by antecedent percutaneous nephrostomy. J Urol. 1978;120(5):543–4.PubMed

25.

Castaneda-Zuniga WR, Clayman R, Smith A, Rusnak B, Herrera M, Amplatz K. Nephrostolithotomy: percutaneous techniques for urinary calculus removal. 1982. J Urol. 2002;167(2 Pt 2):849–53. discussion 54.CrossRefPubMed

26.

Grasso M, Nord R, Bagley DH. Prone split leg and flank roll positioning: simultaneous antegrade and retrograde access to the upper urinary tract. J Endourol. 1993;7(4):307–10. doi:10.1089/end.1993.7.307.CrossRefPubMed

27.

Hamamoto S, Yasui T, Okada A, Taguchi K, Kawai N, Ando R, et al. Endoscopic combined intrarenal surgery for large calculi: simultaneous use of flexible ureteroscopy and mini-percutaneous nephrolithotomy overcomes the disadvantageous of percutaneous nephrolithotomy monotherapy. J Endourol. 2014;28(1):28–33. doi:10.1089/end.2013.0361.CrossRefPubMed

28.

•• Hamamoto S, Yasui T, Okada A, Takeuchi M, Taguchi K, Shibamoto Y, et al. Developments in the technique of endoscopic combined intrarenal surgery in the prone split-leg position. Urology. 2014;84(3):565–70. doi:10.1016/j.urology.2014.04.020. Preferred positioning when performing a PCNL in the prone position.CrossRefPubMed

29.

Kerbl K, Clayman RV, Chandhoke PS, Urban DA, De Leo BC, Carbone JM. Percutaneous stone removal with the patient in a flank position. J Urol. 1994;151(3):686–8.PubMed

30.

Ray AA, Chung DG, Honey RJ. Percutaneous nephrolithotomy in the prone and prone-flexed positions: anatomic considerations. J Endourol. 2009;23(10):1607–14. doi:10.1089/end.2009.0294.CrossRefPubMed

31.

Lehman T, Bagley DH. Reverse lithotomy: modified prone position for simultaneous nephroscopic and ureteroscopic procedures in women. Urology. 1988;32(6):529–31.CrossRefPubMed

32.

Ibarluzea G, Scoffone CM, Cracco CM, Poggio M, Porpiglia F, Terrone C, et al. Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access. BJU Int. 2007;100(1):233–6. doi:10.1111/j.1464-410X.2007.06960.x.CrossRefPubMed

33.

Papatsoris AG, Zaman F, Panah A, Masood J, El-Husseiny T, Buchholz N. Simultaneous anterograde and retrograde endourologic access: “the Barts technique”. J Endourol. 2008;22(12):2665–6. doi:10.1089/end.2008.0283.CrossRefPubMed

34.

Pan TJ, Li GC, Ye ZQ, Wen HD, Shen GQ, Zhang JQ. Flank suspended supine position for percutaneous nephrolithotomy. Urologia. 2012;79(1):58–61. doi:10.5301/RU.2012.9024.CrossRefPubMed

35.

Bach C, Goyal A, Kumar P, Kachrilas S, Papatsoris AG, Buchholz N, et al. The Barts ‘flank-free’ modified supine position for percutaneous nephrolithotomy. Urol Int. 2012;89(3):365–8. doi:10.1159/000341430.CrossRefPubMed

36.

Vicentini FC, Torricelli FC, Mazzucchi E, Hisano M, Murta CB, Danilovic A, et al. Modified complete supine percutaneous nephrolithotomy: solving some problems. J Endourol. 2013;27(7):845–9. doi:10.1089/end.2012.0725.CrossRefPubMed

37.

Sternberg KM, Jacobs BL, King BJ, Wachterman JB, Shahrour K, Theisen KM, et al. The prone ureteroscopic technique for managing large stone burdens. Can J Urol. 2015;22(2):7758–62.PubMed

38.

Pakravan M, Kiavash V, Moradian S. Posterior Ischemic Optic Neuropathy Following Percutaneous Nephrolithotomy. J Ophthalmol. 2006;11(4):558-63

39.

Agah M, Ghasemi M, Roodneshin F, Radpay B, Moradian S. Prone position in percutaneous nephrolithotomy and postoperative visual loss. Urol J. 2011;8(3):191–6.PubMed

40.

Falahatkar S, Asli MM, Emadi SA, Enshaei A, Pourhadi H, Allahkhah A. Complete supine percutaneous nephrolithotomy (csPCNL) in patients with and without a history of stone surgery: safety and effectiveness of csPCNL. Urol Res. 2011;39(4):295–301. doi:10.1007/s00240-010-0341-y.CrossRefPubMed

41.

Liu L, Zheng S, Xu Y, Wei Q. Systematic review and meta-analysis of percutaneous nephrolithotomy for patients in the supine versus prone position. J Endourol. 2010;24(12):1941–6. doi:10.1089/end.2010.0292.CrossRefPubMed

42.

•• Yuan D, Liu Y, Rao H, Cheng T, Sun Z, Wang Y, et al. Supine versus prone position in percutaneous nephrolithotomy for kidney calculi: a meta-analysis. J Endourol. 2016;30(7):754–63. doi:10.1089/end.2015.0402. Meta-analysis comparing supine versus prone PNCL with a robust number of patients.CrossRefPubMed

43.

• Falahatkar S, Mokhtari G, Teimoori M. An update on supine versus prone percutaneous nephrolithotomy: a meta-analysis. Urol J. 2016;13(5):2814–22. Most recent meta-analysis comparing supine versus prone PCNL. Largest meta-analysis completed to date.PubMed

44.

Sharma G, Jangid DK, Yadav SS, Mathur R, Tomar V. Retro-renal colon: role in percutaneous access. Urolithiasis. 2015;43(2):171–5. doi:10.1007/s00240-014-0733-5.CrossRefPubMed

45.

Tuttle DN, Yeh BM, Meng MV, Breiman RS, Stoller ML, Coakley FV. Risk of injury to adjacent organs with lower-pole fluoroscopically guided percutaneous nephrostomy: evaluation with prone, supine, and multiplanar reformatted CT. J Vasc Interv Radiol. 2005;16(11):1489–92. doi:10.1097/01.RVI.0000175331.93499.44.CrossRefPubMed

46.

•• Ghani KR, Andonian S, Bultitude M, Desai M, Giusti G, Okhunov Z, et al. Percutaneous nephrolithotomy: update, trends, and future directions. Eur Urol. 2016;70(2):382–96. doi:10.1016/j.eururo.2016.01.047. Comprehensive review of current PCNL practices and future directions.CrossRefPubMed

47.

AslZare M, Darabi MR, Shakiba B, Gholami-Mahtaj L. Colonic perforation during percutaneous nephrolithotomy: an 18-year experience. Can Urol Assoc J. 2014;8(5-6):E323–6. doi:10.5489/cuaj.1646.CrossRefPubMedPubMedCentral

48.

El-Nahas AR, Shokeir AA, El-Assmy AM, Shoma AM, Eraky I, El-Kenawy MR, et al. Colonic perforation during percutaneous nephrolithotomy: study of risk factors. Urology. 2006;67(5):937–41. doi:10.1016/j.urology.2005.11.025.CrossRefPubMed

49.

Duty B, Okhunov Z, Smith A, Okeke Z. The debate over percutaneous nephrolithotomy positioning: a comprehensive review. J Urol. 2011;186(1):20–5. doi:10.1016/j.juro.2011.02.2693.CrossRefPubMed

50.

Valdivia Uria JG, Valle Gerhold J, Lopez Lopez JA, Villarroya Rodriguez S, Ambroj Navarro C, Ramirez Fabian M, et al. Technique and complications of percutaneous nephroscopy: experience with 557 patients in the supine position. J Urol. 1998;160(6 Pt 1):1975–8.PubMed

51.

Duvdevani M, Razvi H, Sofer M, Beiko DT, Nott L, Chew BH, et al. Third prize: contemporary percutaneous nephrolithotripsy: 1585 procedures in 1338 consecutive patients. J Endourol. 2007;21(8):824–9. doi:10.1089/end.2007.9936.CrossRefPubMed

52.

Adeyouju AAB SN. Anaesthesia for supine and modified supine PNL. In: Scoffone CM, Hoznek A, Cracco CM, editors. Supine Percutaneous Nephrolithotomy and ECIRS The New Way of Interpreting PNL. Springer; 2014. p. XIII, 312 p. 201 illus., 95 illus. in color.

53.

Gamal W, Moursy E, Hussein M, Mmdouh A, Hammady A, Aldahshoury M. Supine pediatric percutaneous nephrolithotomy (PCNL). J Pediatr Urol. 2015;11(2):78. doi:10.1016/j.jpurol.2014.10.012. e1-5.CrossRefPubMed

54.

• Siev M, Motamedinia P, Leavitt D, Fakhoury M, Barcohana K, Hoenig D, et al. Does peak inspiratory pressure increase in the prone position? An analysis related to body mass index. J Urol. 2015;194(5):1302–6. doi:10.1016/j.juro.2015.05.015. Retrospective review of patient’s peak inspiratory pressure in both the supine and prone positions.CrossRefPubMed

55.

Pelosi P, Croci M, Calappi E, Cerisara M, Mulazzi D, Vicardi P, et al. The prone positioning during general anesthesia minimally affects respiratory mechanics while improving functional residual capacity and increasing oxygen tension. Anesth Analg. 1995;80(5):955–60.PubMed

56.

Pelosi P, Croci M, Calappi E, Mulazzi D, Cerisara M, Vercesi P, et al. Prone positioning improves pulmonary function in obese patients during general anesthesia. Anesth Analg. 1996;83(3):578–83.CrossRefPubMed

57.

• Fuller A, Razvi H, Denstedt JD, Nott L, Hendrikx A, Luke M, et al. The clinical research office of the endourological society percutaneous nephrolithotomy global study: outcomes in the morbidly obese patient—a case control analysis. Can Urol Assoc J. 2014;8(5-6):E393–7. doi:10.5489/cuaj.2258. Case control comparison using the CROES database that looks at effects of morbid obesity in PCNL.CrossRefPubMedPubMedCentral

58.

• Yazici CM, Kayhan A, Dogan C. Supine or prone percutaneous nephrolithotomy: do anatomical changes make it worse? J Endourol. 2014;28(1):10–6. doi:10.1089/end.2013.0541. Anatomical considerations as seen on CT scan in the supine, prone and prone-flex position.CrossRefPubMed

59.

Torrecilla Ortiz C, Meza Martinez AI, Vicens Morton AJ, Vila Reyes H, Colom Feixas S, Suarez Novo JF, et al. Obesity in percutaneous nephrolithotomy. Is body mass index really important? Urology. 2014;84(3):538–43. doi:10.1016/j.urology.2014.03.062.CrossRefPubMed

60.

Goumas-Kartalas I, Montanari E. Percutaneous nephrolithotomy in patients with spinal deformities. J Endourol. 2010;24(7):1081–9. doi:10.1089/end.2010.0095.CrossRefPubMed

61.

Osther PJ, Razvi H, Liatsikos E, Averch T, Crisci A, Garcia JL, et al. Percutaneous nephrolithotomy among patients with renal anomalies: patient characteristics and outcomes; a subgroup analysis of the clinical research office of the endourological society global percutaneous nephrolithotomy study. J Endourol. 2011;25(10):1627–32. doi:10.1089/end.2011.0146.CrossRefPubMed

62.

Tepeler A, Sehgal PD, Akman T, Unsal A, Ozyuvali E, Armagan A, et al. Factors affecting outcomes of percutaneous nephrolithotomy in horseshoe kidneys. Urology. 2014;84(6):1290–4. doi:10.1016/j.urology.2014.08.008.CrossRefPubMed

63.

Wu W, Zhao Z, Zhu H, Yang D, Ou L, Liang Y, et al. Safety and efficacy of minimally invasive percutaneous nephrolithotomy in treatment of calculi in horseshoe kidneys. J Endourol. 2014;28(8):926–9. doi:10.1089/end.2013.0760.CrossRefPubMed

64.

Otano N, Jairath A, Mishra S, Ganpule A, Sabnis R, Desai M. Percutaneous nephrolithotomy in pelvic kidneys: is the ultrasound-guided puncture safe? Urology. 2015;85(1):55–8. doi:10.1016/j.urology.2014.08.015.CrossRefPubMed

65.

Violette PD, Dion M, Tailly T, Denstedt JD, Razvi H. Percutaneous nephrolithotomy in patients with urinary tract abnormalities. J Endourol. 2014;28(12):1448–54. doi:10.1089/end.2014.0239.CrossRefPubMed

Title: Prone Versus Supine Percutaneous Nephrolithotomy: What Is Your Position?
Authors: Roshan M. Patel
Zhamshid Okhunov
Ralph V. Clayman
Jaime Landman
Publication date: 01-04-2017
Publisher: Springer US
Published in: Current Urology Reports / Issue 4/2017
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI: https://doi.org/10.1007/s11934-017-0676-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prone Versus Supine Percutaneous Nephrolithotomy: What Is Your Position?

Abstract

Purpose of Review

Recent Findings

Summary

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

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