The effects of position and predictive factors on hypotension in patients undergoing prone percutaneous nephrolithotomy

Seyda Ozgunay; Şermin Eminoglu; Salim Zengin; Selim Yırtımcı; Tuğba Onur; Osman Sıla Aydın

doi:10.66235/kumj.1906298

The effects of position and predictive factors on hypotension in patients undergoing prone percutaneous nephrolithotomy

Abstract

Aims: This study was designed to investigate the effect of prone position and predictive factors on hypotension in patients performing percutaneous nephrolithotomy.

Methods: Patients aged >18 years and ASA I-III who underwent general or regional anaesthesia were included in the study. Percutaneous access was performed in all patients with fluoroscopy in the prone position. Age, gender, body mass index, smoking, type of anaesthesia, duration of anaesthesia and surgery were recorded. The ECG, SpO2, and non-invasive blood pressure values were recorded intraoperatively. Preoperative and postoperative 12th-hour Hb, BUN, Cr, Na, K and Cl were measured in a blood sample. Isotonic was used as an intravenous fluid in all patients. In the treatment of hypotension, routine ephedrine treatments were recorded.

Results: The study included 153 patients, 49 with hypotension in Group H and 104 without hypotension in Group N. Hypertension and coronary artery disease increased the incidence of hypotension (respectively, p=0.028, p=0.007). Patients with hypotension had higher body mass index (p=0.044). Hypotension was found to be significantly higher in patients who underwent regional anaesthesia and had a large number of percutaneous accesses (respectively, p=0.048, and p=0.012). Age-Adjusted Charlson Index, ASA, smoking, and hospital stay were not statistically different.

Conclusion: Hypertension and coronary artery disease increased the risk of hypotension during PCNL procedures in the prone position. In addition, high body mass index, an increase in the number of percutaneous accesses, and the use of regional anaesthesia also increase the risk of hypotension during the performance of percutaneous nephrolithotomy procedures.

Keywords

Ethical Statement

Ethical approval for the study was obtained from the Non-Interventional Research Ethics Committee of Bursa Yuksek Ihtisas Training and Research Hospital, Date: 17.03.2021, Decision No: 2011-KAEK-25 2021/03-14.

References

1. Pearle MS, Lotan Y. Section XI: Urinary lithiasis: etiology, epidemiology, and pathogenesis. In: Campbell MF, Wein AJ, Kavoussi LR (ed). Campbell-Walsh Urology.9th Edn. Saunders Elsevier, Philadelphia, 2007;1363-92.
2. Dar MA, Malik SA, Dar YA, et al. Comparison of percutaneous nephrolithotomy under epidural anaesthesia versus general anaesthesia: A randomized prospective study. Urol Ann. 2021;13(3):210-4. doi:10.4103/UA.UA_82_20
3. Tangpaitoon T, Nisoog C, Lojanapiwat B. Efficacy and safety of percutaneous nephrolithotomy (PCNL): a prospective and randomized study comparing regional epidural anaesthesia with general anaesthesia. Int Braz J Urol. 2012;38:504-11. doi: 10.1590/s1677-55382012000400010
4. Khoshrang H, Falahatkar S, Ilat S, et al. Comparative study of hemodynamics electrolyte and metabolic changes during prone and complete supine percutaneous nephrolithotomy. Nephrourol Mon. 2012;4(4):622-8. doi: 10.5812/numonthly.4099
5. DasGupta R, Patel A. Percutaneous nephrolithotomy: does position matter? prone, supine and variations. Curr Opin Urol. 2013; 23(2): 164-8. doi: 10.1097/MOU.0b013e32835d3067
6. Salmasi V, Maheshwari K, Yang D, et al. Relationship between intraoperative hypotension, defined by either reduction from baseline or absolute thresholds, and acute kidney and myocardial injury after noncardiac surgery: a retrospective cohort analysis. Anesthesiology. 2017;126(1):47-65. doi:10.1097/ALN.0000000000001432
7. Monk TG, Bronsert MR, Henderson WG, et al. Association between intraoperative hypotension and hypertension and 30-day postoperative mortality in noncardiac surgery. Anesthesiology. 2015;123(2):307-19. doi:10.1097/ALN.0000000000000756
8. Walsh M, Devereaux PJ, Garg AX, et al. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension. Anesthesiology. 2013;119(3):507-15. doi: 10.1097/ALN.0b013e3182a10e26

9. An R, Pang Q-Y, Liu HL. Association of intra‐operative hypotension with acute kidney injury, myocardial injury and mortality in non‐cardiac surgery: A meta‐analysis. Int J Clin Pract. 2019;73(10): e13394. doi: 10.1111/ijcp.13394
10. Vernooij L, Van Klei W, Machina M, Pasma W, Beattie W, Peelen L. Different methods of modelling intraoperative hypotension and their association with postoperative complications in patients undergoing non-cardiac surgery. Br J Anaesth. 2018;120(5):1080-9. doi: 10.1016/j.bja.2018.01.033
11. Overgaard CB, Dzavík V. Inotropes and vasopressors: review of physiology and clinical use in cardiovascular disease. Circulation. 2008;118(10):1047-56. doi: 10.1161/CIRCULATIONAHA.107.728840
12. Unsal A, Resorlu B, Atmaca AF, et al. Prediction of morbidity and mortality after percutaneous nephrolithotomy by using the Charlson Comorbidity Index. Urology. 2012;79(1):55-60. doi:10.1016/j.urology.2011.06.038
13. Inanloo SH, Yahyazadeh SR, Rashidi S, et al. Feasibility and safety of ultrasonography guidance and flank position during percutaneous nephrolithotomy. J Urol. 2018;200(1):195-201. doi:10.1016/j.juro.2018.02.074
14. Mano R, Tin AL, Silagy AW, et al. The association between modifiable perioperative parameters and renal function after nephrectomy. BJU Int. 2022;129(3):380-386. doi: 10.1111/bju.15531
15. Saugel B, Sessler DI. Perioperative blood pressure management. Anesthesiology. 2021;134(2):250-61. doi: 10.1097/ALN.0000000000003610
16. Awad H, Alcodray G, Raza A, et al. Intraoperative Hypotension–Physiologic Basis and Future Directions. J Cardiothorac Vasc Anesth. 2022;36(7):2154-63. doi:10.1053/j.jvca.2021.05.057
17. Melo PA de S, Vicentini FC, Perrella R, Murta CB, Claro JF de A. Comparative study of percutaneous nephrolithotomy performed in the traditional prone position and in three different supine positions. Int braz j urol. 2019;45(1):108–17. doi:10.1590/S1677-5538.IBJU.2018.0191
18. Sudheer PS, Logan SW, Ateleanu B, Hall JE. Haemodynamic effects of the prone position: a comparison of propofol total intravenous and inhalation anaesthesia. Anaesthesia. 2006;61(2):138–141. doi: 10.1111/j.1365-2044.2005.04464.x
19. Mokhtari MR, Farshid S, Modresi P, Abedi F. The Effects of Tranexamic Acid on Bleeding Control During and after Percutaneous Nephrolithotomy (PCNL): A Randomized Clinical Trial. Urol J. 2021;18(6):608-611. doi: 10.22037/uj.v18i.6505
20. Bhatia VP, Aro T, Smith SM, et al. Frailty as predictor of complications in patients undergoing percutaneous nephrolithotomy (PCNL). World Journal of Urology. 2021;1-7. doi:10.1007/s00345-021-03681-x
21. Kamal M, Sharma P, Singariya G, Jain R. Feasibility and complications of spinal anaesthesia in percutaneous nephrolithotomy: our experience. J Clin Diagn Res. 2017;11(6):UC08-11. doi:10.7860/JCDR/2017/26425.10111
22. de la Rosette JJ, Tsakiris P, Ferrandino MN, Elsakka AM, Rioja J, Preminger GM. Beyond prone position in percutaneous nephrolithotomy: a comprehensive review. Eur Urol. 2008;54(6):1262-9. doi: 10.1016/j.eururo.2008.08.012
23. Ozgor F, Ucpinar B, Binbay M. Effect of obesity on prone percutaneous nephrolithotomy outcomes: a systemic review. Eur Urol. 2016;13(1):2471-8.

Details

Primary Language

English

Subjects

Anaesthesiology

Journal Section

Research Article

Authors

Seyda Ozgunay
0000-0003-1501-9292
Türkiye

Şermin Eminoglu
0000-0001-5741-2960
Türkiye

Salim Zengin
0000-0002-7837-6767
Türkiye

Selim Yırtımcı
0000-0001-8417-0178
Türkiye

Tuğba Onur
0000-0002-5080-4555
Türkiye

Osman Sıla Aydın
0000-0001-7188-8658
Türkiye

Publication Date

March 12, 2026

Submission Date

July 17, 2025

Acceptance Date

November 11, 2025

Published in Issue

Year 2026 Volume: 6 Number: 1

DOI

https://doi.org/10.66235/kumj.1906298

IZ

https://izlik.org/JA26PX95AU

Cite

RIS / Bibtex

APA

Ozgunay, S., Eminoglu, Ş., Zengin, S., Yırtımcı, S., Onur, T., & Aydın, O. S. (2026). The effects of position and predictive factors on hypotension in patients undergoing prone percutaneous nephrolithotomy. Kastamonu Medical Journal, 6(1), 25-33. https://doi.org/10.66235/kumj.1906298

AMA

1.Ozgunay S, Eminoglu Ş, Zengin S, Yırtımcı S, Onur T, Aydın OS. The effects of position and predictive factors on hypotension in patients undergoing prone percutaneous nephrolithotomy. Kastamonu Medical Journal. 2026;6(1):25-33. doi:10.66235/kumj.1906298

Chicago

Ozgunay, Seyda, Şermin Eminoglu, Salim Zengin, Selim Yırtımcı, Tuğba Onur, and Osman Sıla Aydın. 2026. “The Effects of Position and Predictive Factors on Hypotension in Patients Undergoing Prone Percutaneous Nephrolithotomy”. Kastamonu Medical Journal 6 (1): 25-33. https://doi.org/10.66235/kumj.1906298.

EndNote

Ozgunay S, Eminoglu Ş, Zengin S, Yırtımcı S, Onur T, Aydın OS (March 1, 2026) The effects of position and predictive factors on hypotension in patients undergoing prone percutaneous nephrolithotomy. Kastamonu Medical Journal 6 1 25–33.

IEEE

[1]S. Ozgunay, Ş. Eminoglu, S. Zengin, S. Yırtımcı, T. Onur, and O. S. Aydın, “The effects of position and predictive factors on hypotension in patients undergoing prone percutaneous nephrolithotomy”, Kastamonu Medical Journal, vol. 6, no. 1, pp. 25–33, Mar. 2026, doi: 10.66235/kumj.1906298.

ISNAD

Ozgunay, Seyda - Eminoglu, Şermin - Zengin, Salim - Yırtımcı, Selim - Onur, Tuğba - Aydın, Osman Sıla. “The Effects of Position and Predictive Factors on Hypotension in Patients Undergoing Prone Percutaneous Nephrolithotomy”. Kastamonu Medical Journal 6/1 (March 1, 2026): 25-33. https://doi.org/10.66235/kumj.1906298.

JAMA

1.Ozgunay S, Eminoglu Ş, Zengin S, Yırtımcı S, Onur T, Aydın OS. The effects of position and predictive factors on hypotension in patients undergoing prone percutaneous nephrolithotomy. Kastamonu Medical Journal. 2026;6:25–33.

MLA

Ozgunay, Seyda, et al. “The Effects of Position and Predictive Factors on Hypotension in Patients Undergoing Prone Percutaneous Nephrolithotomy”. Kastamonu Medical Journal, vol. 6, no. 1, Mar. 2026, pp. 25-33, doi:10.66235/kumj.1906298.

Vancouver

1.Seyda Ozgunay, Şermin Eminoglu, Salim Zengin, Selim Yırtımcı, Tuğba Onur, Osman Sıla Aydın. The effects of position and predictive factors on hypotension in patients undergoing prone percutaneous nephrolithotomy. Kastamonu Medical Journal. 2026 Mar. 1;6(1):25-33. doi:10.66235/kumj.1906298