Complete Supine Percutaneous Nephrolithotripsy Comparison With The Prone Standard Technique

Main Category: Urology / Nephrology
Article Date: 02 Feb 2009 - 5:00 PDT

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UroToday.com - The supine approach to percutaneous nephrostolithotomy (PCNL) appears to be well practiced and perfected in many countries outside of North America. Excellent outcomes have been reported by groups in Spain, Egypt, and other countries.

What has been missing, until now, is a prospective randomized study. In this study of 80 patients randomized to prone or supine PCNL, the KUB stone free rate was 80% and 78%, respectively with a statistically significant shorter operative time of 1.25 hrs. (supine) vs. 1.6 hrs (prone). There was no difference in blood loss; however, transfusion was more common among the supine (20%) than the prone patients (7.5%) (p > 0.05). Of note, with the supine access, there was no case of an inaccessible calyx and no colon injuries, despite all accesses being subcostal and predominantly lower pole. The upper pole was accessed in 10% of supine cases, most commonly as a secondary tract. Of interest, more secondary tracts were placed in the prone (14) than in the supine (8) patients.

Advantages of the supine approach include: simpler draping of the patient, easier ability to do cystoscopy or ureteroscopy during the procedure, enhanced control of the airway by the anesthesiologist, and a seated, more comfortable surgeon.

This is a well-done study and may well convince others to now use the supine approach to PCNL.

Falahatkar S, Moghaddam AA, Salehi M, Nikpour S, Esmaili F, Khaki N
J Endourol. 2008 Nov;22(11):2513-7.
doi:10.1089/end.2008.0463

Reported by UroToday.com Medical Editor Ralph V. Clayman, MD

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