Skip to main content
Log in

Supine versus prone position in percutaneous nephrolithotomy for kidney calculi: a meta-analysis

  • Urology – Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Background

Supine position and prone position were the choice for percutaneous nephrolithotomy (PCNL). However, there is still no consensus on the optimal position for PCNL.

Methods

A systematic literature review was performed, searching Pubmed, Embase, CENTRAL and reference lists for relevant studies. Data from all selected articles were extracted independently by two reviewers and analyzed by RevMan 5 software.

Results

Four comparative studies involving 389 cases and 27 case series studies including 1,469 renal units of supine position and 4,837 renal units of prone position were identified. With reference to comparative studies, the mean stone length and the proportions of staghorn and multiple stones were comparable between two positions. There was no significant difference in terms of stone-free rate (risk ratio = 1.00, 95% confidence interval: 0.92 to 1.09; 82.4 vs. 82.1%) and bleeding. The rate of colonic injury in supine PCNL was approximate 0.5% and incidence of pleural injury of 0% was noted for both positions. Pelvic perforation and failed access were comparable between supine and prone position. The operative times of supine position significantly decreased (65±15 vs. 90±15 min; mean difference = −24.76, 95% confidence interval: −39.36 to −10.15), but no significant difference was found in mean days hospital stay. Analysis based on the case series showed larger proportion of staghorn and multiple calculi in prone position (45.8 vs. 31.7%), the supine PCNL had slightly lower bleeding and similar stone-free rate compared with the prone position.

Conclusions

For general patients with kidney calculi, PCNL in supine position has similar stone-free rate compared with prone. Supine PCNL do not increase related complications. The operative times significantly decrease in supine position.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Goodwin WE, Casey WC, Woolf W (1955) Percutaneous trocar (needle) nephrostomy in hydronephrosis. J Am Med Assoc 157:891–894

    PubMed  CAS  Google Scholar 

  2. Fernstrom I, Johansson B (1976) Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol 10:257–259

    PubMed  CAS  Google Scholar 

  3. Valdivia Uria JG, Valle Gerhold J, Lopez Lopez JA et al (1998) Technique and complications of percutaneous nephroscopy: experience with 557 patients in the supine position. J Urol 160:1975–1978

    Article  PubMed  CAS  Google Scholar 

  4. De Sio M, Autorino R, Quarto G et al (2008) Modified supine versus prone position in percutaneous nephrolithotomy for renal stones treatable with a single percutaneous access: a prospective randomized trial. Eur Urol 54:196–202

    Article  PubMed  Google Scholar 

  5. Falahatkar S, Moghaddam AA, Salehi M et al (2008) Complete supine percutaneous nephrolithotripsy comparison with the prone standard technique. J Endourol 22:2513–2517

    Article  PubMed  Google Scholar 

  6. Shoma AM, Eraky I, El-Kenawy MR et al (2002) Percutaneous nephrolithotomy in the supine position: technical aspects and functional outcome compared with the prone technique. Urology 60:388–392

    Article  PubMed  Google Scholar 

  7. Amon Sesmero JH, Del Valle Gonzalez N, Conde Redondo C et al (2008) Comparison between Valdivia position and prone position in percutaneous nephrolithotomy. Actas Urol Esp 32:424–429

    Article  PubMed  CAS  Google Scholar 

  8. Steele D, Marshall V (2007) Percutaneous nephrolithotomy in the supine position: a neglected approach? J Endourol 21:1433–1437

    Article  PubMed  Google Scholar 

  9. Zhou X, Gao X, Wen J et al (2008) Clinical value of minimally invasive percutaneous nephrolithotomy in the supine position under the guidance of real-time ultrasound: report of 92 cases. Urol Res 36:111–114

    Article  PubMed  Google Scholar 

  10. Rana AM, Bhojwani JP, Junejo NN et al (2008) Tubeless PCNL with patient in supine position: procedure for all seasons?—with comprehensive technique. Urology 71:581–585

    Article  PubMed  Google Scholar 

  11. Scoffone CM, Cracco CM, Cossu M et al (2008) Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: a new standard for percutaneous nephrolithotomy? Eur Urol 54:1393–1403

    Article  PubMed  Google Scholar 

  12. Manohar T, Jain P, Desai M (2007) Supine percutaneous nephrolithotomy: effective approach to high-risk and morbidly obese patients. J Endourol 21:44–49

    Article  PubMed  CAS  Google Scholar 

  13. Ng MT, Sun WH, Cheng CW et al (2004) Supine position is safe and effective for percutaneous nephrolithotomy. J Endourol 18:469–474

    Article  PubMed  Google Scholar 

  14. Neto EA, Mitre AI, Gomes CM et al (2007) Percutaneous nephrolithotripsy with the patient in a modified supine position. J Urol 178:165–168

    Article  PubMed  Google Scholar 

  15. Yadav R, Aron M, Gupta NP et al (2006) Safety of supracostal punctures for percutaneous renal surgery. Int J Urol 13:1267–1270

    Article  PubMed  Google Scholar 

  16. Aron M, Yadav R, Goel R et al (2005) Multi-tract percutaneous nephrolithotomy for large complete staghorn calculi. Urol Int 75:327–332

    Article  PubMed  Google Scholar 

  17. Koo BC, Burtt G, Burgess NA (2004) Percutaneous stone surgery in the obese: outcome stratified according to body mass index. BJU Int 93:1296–1299

    Article  PubMed  CAS  Google Scholar 

  18. Basiri A, Mehrabi S, Kianian H et al (2007) Blind puncture in comparison with fluoroscopic guidance in percutaneous nephrolithotomy: a randomized controlled trial. Urol J 4:79–83

    PubMed  Google Scholar 

  19. Basiri A, Ziaee AM, Kianian HR et al (2008) Ultrasonographic versus fluoroscopic access for percutaneous nephrolithotomy: a randomized clinical trial. J Endourol 22:281–284

    Article  PubMed  Google Scholar 

  20. Osman M, Wendt-Nordahl G, Heger K et al (2005) Percutaneous nephrolithotomy with ultrasonography-guided renal access: experience from over 300 cases. BJU Int 96:875–878

    Article  PubMed  Google Scholar 

  21. Holman E, Salah MA, Tóth C (2002) Comparison of 150 simultaneous bilateral and 300 unilateral percutaneous nephrolithotomies. J Endourol 16:33–36

    Article  PubMed  Google Scholar 

  22. Yadav R, Gupta NP, Gamanagatti S (2008) Supra-twelfth supracostal access: when and where to puncture? J Endourol 22:1209–1212

    Article  PubMed  Google Scholar 

  23. Sofikerim M, Demirci D, Huri E et al (2007) Tubeless percutaneous nephrolithotomy: safe even in supracostal access. J Endourol 21:967–972

    Article  PubMed  Google Scholar 

  24. Wong MY (1998) Evolving technique of percutaneous nephrolithotomy in a developing country: Singapore General Hospital experience. J Endourol 12:397–401

    Article  PubMed  CAS  Google Scholar 

  25. Tefekli A, Ali Karadag M, Tepeler K et al (2008) Classification of percutaneous nephrolithotomy complications using the modified clavien grading system: looking for a standard. Eur Urol 53:184–190

    Article  PubMed  Google Scholar 

  26. Ziaee SA, Karami H, Aminsharifi A (2007) One-stage tract dilation for percutaneous nephrolithotomy: is it justified? J Endourol 21:1415–1420

    Article  PubMed  Google Scholar 

  27. Portis AJ, Laliberte MA, Holtz C et al (2008) Confident intraoperative decision making during percutaneous nephrolithotomy: does this patient need a second look? Urology 71:218–222

    Article  PubMed  Google Scholar 

  28. Raza A, Moussa S, Smith G et al (2008) Upper-pole puncture in percutaneous nephrolithotomy: a retrospective review of treatment safety and efficacy. BJU Int 101:599–602

    Article  PubMed  Google Scholar 

  29. Meinbach DS, Modling D (2008) Percutaneous management of large renal stones in a private practice community setting. J Endourol 22:447–451

    Article  PubMed  Google Scholar 

  30. Margel D, Lifshitz DA, Kugel V et al (2005) Percutaneous nephrolithotomy in patients who previously underwent open nephrolithotomy. J Endourol 19:1161–1164

    Article  PubMed  Google Scholar 

  31. El-Assmy AM, Shokeir AA, El-Nahas AR et al (2007) Outcome of percutaneous nephrolithotomy: effect of body mass index. Eur Urol 52:199–204

    Article  PubMed  Google Scholar 

  32. Pearle MS, Nakada SY, Womack JS et al (1998) Outcomes of contemporary percutaneous nephrostolithotomy in morbidly obese patients. J Urol 160:669–673

    Article  PubMed  CAS  Google Scholar 

  33. Sergeyev I, Koi PT, Jacobs SL et al (2007) Outcome of percutaneous surgery stratified according to body mass index and kidney stone size. Surg Laparosc Endosc Percutan Tech 17:179–183

    Article  PubMed  Google Scholar 

  34. Clayman RV (2005) Percutaneous nephrolithotomy: an update. J Urol 173:1199

    Google Scholar 

  35. Autorino R, Giannarini G (2008) Prone or supine: is this the question? Eur Urol 54:1216–1218

    Article  PubMed  Google Scholar 

  36. Ibarluzea G, Scoffone CM, Cracco CM et al (2007) Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access. BJU Int 100:233–236

    Article  PubMed  Google Scholar 

  37. de la Rosette JJ, Tsakiris P, Ferrandino MN et al (2008) Beyond prone position in percutaneous nephrolithotomy: a comprehensive review. Eur Urol 54:1262–1269

    Article  Google Scholar 

  38. Vicentini FC, Gomes CM, Danilovic A et al (2009) Percutaneous nephrolithotomy: current concepts. Indian J Urol 25:4–10

    Article  PubMed  Google Scholar 

  39. LeRoy AJ, Williams HJ Jr, Bender CE et al (1985) Colon perforation following percutaneous nephrostomy and renal calculus removal. Radiology 155:83–85

    PubMed  CAS  Google Scholar 

  40. Preminger GM, Schultz S, Clayman RV et al (1987) Cephalad renal movement during percutaneous nephrostolithotomy. J Urol 137:623–625

    PubMed  CAS  Google Scholar 

Download references

Disclosures

No financial support was obtained from any institution or company except for logistic support from the authors’ affiliation departments.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kunjie Wang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wu, P., Wang, L. & Wang, K. Supine versus prone position in percutaneous nephrolithotomy for kidney calculi: a meta-analysis. Int Urol Nephrol 43, 67–77 (2011). https://doi.org/10.1007/s11255-010-9801-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-010-9801-0

Keywords

Navigation