Comparison Between Supine Position Versus Prone Position in Percutaneous Nephrolithotomy

Abstract

Objective: To compare and evaluate the efficacy and safety of percutaneous nephrolithotomy (PCNL) performed in prone and supine positions.

Methodology:  This prospective randomized trial study was conducted at the Urology department of Nishtar Hospital Multan from January 2023 to December 2023. A total of 174 patients who underwent PCNL in either prone or supine positions were enrolled. Patients with stones larger than 2 centimeters or those who had failed shock wave lithotripsy (SWL) therapies Follow-up was completed by 174 patients, among whom 87 underwent prone PCNL (Group A) and 87 underwent supine PCNL(Group B),  with the surgical position determined by the surgeon's preference. Chi-square test was applied to check the significance of categorical variables and student t test was applied to check significance the difference between two means. One way ANOVA was applied to the significant difference between more than two means. p values below 0.05 was taken as significant. 

Results: The mean operative time of Group A (prone position) was greater than the Group B (supine position), 77.60±3.76 minutes and 71.61±13.58 minutes, respectively. Analgesia during procedure was given 42.5% to Group A (prone position) and 27.6% to Group B, (p=0.039). The mean length of hospital stay of Group A (prone position) was greater than the Group B, 62.00±3.72 hours and 51.62±10.41 hours, respectively. The presence of postoperative complications urinary leakage was 5.7% in Group A and 3.7% in group B, blood transfusion was 6.9 and 1.1 in Group A and group B, angioembolization was 4.6 and 0.0% in Group A  and group B, fever >990F was the most common complication, 12.6% in Group A and 17.2% in Group B. 

Conclusion: Both procedures have equal efficacy and safety as PCNL in supine position is associated with advantages of shorter operating time, less analgesia requirement and shorter hospital stay and prone position PCNL associated with better stone clearance rate and less complication of fever.