Supine and Prone Positions in Percutaneous Nephrolithotomy: Exploring Their Roles in Operative Efficiency and Patient Comfort

Abstract

Aim: This study aimed to compare the effects of supine and prone positions during percutaneous nephrolithotomy (PCNL) on operative characteristics, patient out-comes and postoperative quality of recovery. Material and Methods: A retrospective analysis was conducted on 78 patients who underwent PCNL for renal stones ≥2 cm at a single center between December 2022 and August 2024. Patients were divided into two groups: 41 treated in the mini-PCNL (mPCNL) supine position and 37 in the standart PCNL (sPCNL) prone position. Demographic data, operative time, hospital stay duration, complication rates, postoperative pain and analgesic requirements and quality of recovery scores (QoR) were compared. Treatment efficacy was assessed based on residual stone presence at 2 months postoperatively, with <2 mm considered stone-free. Results: Operative and access times were significantly shorter in the supine group and these patients had a reduced hospital stay. Quality of recovery improvement was more pronounced in the supine group with lower postoperative pain and analgesic requirements. Additionally, supine-positioned patients had a lower rate of residual stones compared to the prone group, suggesting enhanced treatment efficacy. Conclusion: The supine position in mPCNL offers advantages over the prone position in terms of operative efficiency, patient comfort and postoperative quality of recovery. Given these benefits the supine position may be a preferable choice for PCNL procedures. Further multicenter studies are recommended to validate these findings across broader patient populations.

Keywords

• Percutaneous nephrolithotomy
• supine position
• prone position
• quality of life
• quality of recovery
• renal stone
• postoperative outcomes

Perkütan Nefrolitotomide Supine ve Prone Pozisyonları: Operasyon Etkinliği ve Hasta Konforundaki Rolleri

Abstract

Amaç: Bu çalışma, perkütan nefrolitotomi (PCNL) sırasında supine ve prone pozisyonlarının operasyon özellikleri, hasta sonuçları ve postoperatif iyileşme kalitesi üzerindeki etkilerini karşılaştırmayı hedeflemiştir. Gereç ve Yöntemler: Aralık 2022 ile Ağustos 2024 tarihleri arasında tek bir merkezde renal taş (>2 cm) nedeniyle PCNL uygulanan 78 hastanın retrospektif analizi yapılmıştır. Hastalar, mini-PCNL (mPCNL) supine pozisyonunda tedavi edilen 41 hasta ve standart PCNL (sPCNL) prone pozisyonunda tedavi edilen 37 hasta olmak üzere iki gruba ayrılmıştır. Demografik veriler, operasyon süresi, hastanede yatış süresi, komplikasyon oranları, postoperatif ağrı ve analjezik gereksinimi ile iyileşme kalitesi skorları (QoR) karşılaştırılmıştır. Tedavi etkinliği, ameliyat sonrası 2. ayda taşsızlık (<2 mm rezidü taş) oranı üzerinden değerlendirilmiştir. Bulgular: Operasyon ve akses süreleri supine grubunda anlamlı olarak daha kısa bulunmuş ve bu grup hastalarında hastanede yatış süresi daha kısa olmuştur. Supine grubunda iyileşme kalitesinde daha belirgin bir iyileşme gözlenmiş, postoperatif ağrı ve analjezik gereksinimleri daha az olmuştur. Ayrıca, supine pozisyonda tedavi edilen hastalarda rezidü taş oranı prone grubuna kıyasla daha düşük bulunmuş ve bu durum tedavi etkinliğinin artmış olduğunu göstermektedir. Sonuç: mPCNL’de supine pozisyonu, operatif verimlilik, hasta konforu ve postoperatif yaşam kalitesi açısından prone pozisyonuna göre avantajlar sunmaktadır. Bu faydalar göz önünde bulundurulduğunda, PCNL prosedürleri için supine pozisyonu tercih edilebilir bir seçenek olabilir. Daha geniş hasta popülasyonlarında bu bulguların doğrulanması için çok merkezli çalışmalar önerilmektedir.

Keywords

• Perkütan Nefrolitotomi
• Supine Pozisyon
• Prone Pozisyon
• Yaşam Kalitesi
• İyileşme Kalitesi
• Renal Taş
• Postoperatif Sonuçlar

References

1. Zhao Z, Fan J, Liu Y, de la Rosette J, Zeng G. Percutaneous nephrolithotomy: position, position, position!. Urolithiasis. 2018; 46(1): 79-86.
2. Knoll T, Daels F, Desai J, Hoznek A, Knudsen B, Montanari E, et al. Percutaneous nephrolithotomy: technique. World J Urol. 2017; 35(9): 1361-8.
3. Farkouh Aa, Park K, Buell MI, Mack N, De Guzman C, Clark T, et al. Prone vs supine percutaneous nephrolithotomy: does position affect renal pelvic pressures? Urolithiasis. 2024; 52(1): 66.
4. Marchini GS, Berto FCG, Vicentini FC, Shan CJ, Srougi M, Mazzucchi E. Preoperative planning with noncontrast computed tomography in the prone and supine position for percutaneous nephrolithotomy: a practical overview. Journal of endourology. 2015; 29(1): 6-12.
5. Sofer M, Tavdi E, Levi O, Mintz I, Bar-Yosef Y, Sidi A, et al. Implementation of supine percutaneous nephrolithotomy: a novel position for an old operation. Central European journal of urology. 2017; 70(1): 60.
6. Cracco CM, Scoffone CM. ECIRS (Endoscopic Combined Intrarenal Surgery) in the Galdakao-modified supine Valdivia position: a new life for percutaneous surgery? World journal of urology. 2011; 29: 821-7.
7. Scoffone CM, Cracco CM. Invited review: the tale of ECIRS (Endoscopic Combined IntraRenal Surgery) in the Galdakao-modified supine Valdivia position. Urolithiasis. 2018; 46(1): 115-23.
8. Phoophiboon V, Owattanapanich N, Owattanapanich W, Schellenberg M. Effects of prone positioning on ARDS outcomes of trauma and surgical patients: a systematic review and meta-analysis. BMC pulmonary medicine. 2023;23(1):504.

9. Kwee MM, Ho Y-H, Rozen WM. The prone position during surgery and its complications: a systematic review and evidence-based guidelines. International surgery. 2015; 100(2): 292-303.
10. Okhunov Z, Friedlander JI, George AK, Duty BD, Moreira DM, Srinivasan AK, et al. STONE nephrolithometry: novel surgical classification system for kidney calculi. Urology. 2013; 81(6): 1154-60.
11. Selvi O, Azizoğlu M, Temel G, Tulgar S, Chitneni A, Çınar EN, et al. Translation and validation of the Turkish version of the quality of postoperative recovery score QoR-15: A multi-centred cohort study. Turkish Journal of Anaesthesiology and Reanimation. 2022; 50(6): 443.
12. Ferakis N, Stavropoulos M. Mini percutaneous nephrolithotomy in the treatment of renal and upper ureteral stones: Lessons learned from a review of the literature. Urology annals. 2015; 7(2): 141-8.
13. Karaolides T, Moraitis K, Bach C, Masood J, Buchholz N. Positions for percutaneous nephrolithotomy: Thirty-five years of evolution. Arab Journal of Urology. 2012; 10(3): 307-16.
14. Kumar P, Bach C, Kachrilas S, Papatsoris AG, Buchholz N, Masood J. Supine percutaneous nephrolithotomy (PCNL):‘in vogue’but in which position? BJU international. 2012; 110(11c): E1018-E21.
15. Giusti G, Pavia MP, Rico L, Proietti S. Percutaneous nephrolithotomy: which position? Supine position! European Urology Open Science. 2022; 35: 1-3.
16. Tsaturyan A, Vrettos T, Liourdi D, Lattarulo M, Liatsikos E, Kallidonis P. Position-related anesthesiologic considerations and surgical outcomes of prone percutaneous nephrolithotomy: a review of the current literature. Minerva Urology and Nephrology. 2022; 74(6): 695-702.
17. Zanaty F, Mousa A, Elgharabawy M, Elshazly M, Sultan S. A prospective, randomized comparison of standard prone position versus flank-free modified supine position in percutaneous nephrolithotomy: A single-center initial experience. Urology Annals. 2022; 14(2): 172-6.
18. Kucukyangoz M, Gucuk A. Which position is more advantageous for percutaneous nephrolithotomy: supine or prone? Urolithiasis. 2023; 51(1): 102.
19. 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. Journal of endourology. 2011; 25(10): 1619-25.
20. Erbin A, Ozdemir H, Sahan M, Savun M, Cubuk A, Yazici O, et al. Comparison of supine and prone miniaturized percutaneous nephrolithotomy in the treatment of lower pole, middle pole and renal pelvic stones: A matched pair analysis. International braz j urol. 2019; 45: 956-64.
21. Eryılmaz R, Ertas K, Aslan R, Sevim M, Keles MF, Taken K. Comparison of supine–prone percutaneous nephrolithotomy methods in the treatment of kidney stones in pediatric patients: prospective randomized study. Urolithiasis. 2024; 52(1): 73.
22. Mazzon G, Choong S, Pavan N, Zeng G, Wu W, Durutovic O, et al. Introducing trifecta for percutaneous nephrolithotomies: a proposal for standard reporting outcomes after treatment for renal stones. Minerva Urology and Nephrology. 2021; 74(3): 351-9.
23. De Bayser H, Neuville P, Etienne J, Paparel P, Badet L, Abid N. Quality of life of patients treated for kidney stones 10–20 mm in diameter in terms of the type of operation performed: A qualitative study. Progrès en Urologie. 2023; 33(2): 88-95.
24. Hazır B, Çak HT, Saruhan K, Tekgül S, Doğan HS. Factors affecting the postoperative quality of life and psychological well-being in pediatric urology patients. Journal of Pediatric Urology. 2023; 19(4): 435. e1-. e8.
25. Qi Y, Kong H, Xing H, Zhang Z, Chen Y, Qi S. A randomized controlled study of ureteral stent extraction string on patient’s quality of life and stent-related complications after percutaneous nephrolithotomy in the prone position. Urolithiasis. 2023; 51(1): 79.
26. Birowo P, Tendi W, Widyahening IS, Rasyid N, Atmoko W. Supine versus prone position in percutaneous nephrolithotomy: a systematic review and meta-analysis. F1000Research. 2020; 9: 231.
27. 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 I. The Journal of urology. 2016; 196(4): 1153-60.
28. Kucukyangoz M, Gucuk A. What should the optimal access site be for percutaneous treatment of anterior lower pole calyx stones? World Journal of Urology. 2024; 42(1): 176.
29. Oner S, Akgul AK, Demirbas M, Onen E, Aydos M, Erdogan A. Upper pole access is safe and effective for pediatric percutaneous nephrolithotomy. Journal of pediatric urology. 2018; 14(2): 183. e1-. e8.