EAU 2017: Safety And Efficacy Of Percutaneous Nephrolithotripsy (Pnl) In Supine Versus Prone Position: A Randomized Controlled Trial

London, England (UroToday.com) Positioning for percutaneous nephrolithotomy (PCNL) still remains as a topic for a debate. Traditionally, prone position has been used since the inception of the PCNL techniques. However, in the early 1990’s supine position was proposed as an alternative positioning option for prone PCNL. Later publications have shown that the supine positioning is although challenging with experience and highly selected patients is a feasible and in certain situations advantageous to traditional prone positioning.

Continuous retrospective research has clearly delineated patient selection and indications for both positions. However, to this date there is a lack of high quality prospective randomized trial comparing two positions for PCNL.

Abouelgreed and colleagues from Alazhar University presented their data on prospective randomized clinical trial on prone versus supine positioning for PCNL. They carefully compared patients’ characteristics, pero and postoperative data on both approaches. Primary outcomes of the study was safety and complications associated with both positions in patients undergoing PCNL.

As authors presented, the study included a total of 100 patients. All these were prospectively enrolled at a single institution between December 2011 and August 2015. The mean age was 42.7 with the range of 20-65 years. The patients were randomized on a basis of 1:1 ratio into two groups (50 patients each). All patients were evaluated by detailed clinical history, general and local examination, complete laboratory assessment. The follow up assessment included of KUB, IVP and/ or spiral CT examinations and stone free was defined as an absence of any stone particles on any imaging modality obtained on postoperative day 1.

Study demonstrated that patient characteristics and demographics were comparable and there was no significant difference in preoperative, intraoperative and postoperative parameters including the complications between both groups. However, mean operative time for patients in patients in supine positions that was significantly less than the patients in prone position with a statistically significant difference (p < 0.0001). We mainly attributed this to the time lost in turning the patient at the beginning and end of the procedure when it is done in the prone position.

Authors’ concluded that supine position PNL is a safe and successful procedure with minimal complications and comparable results to the conventional prone position PNL with shorter operative time and being more suitable for compromised cardiopulmonary patients, morbidly obese patients and those with stature deformities.

This is indeed a pivotal study and one of the first randomized prospective studies demonstrating that supine is a safe and feasible and provides non-inferior results to traditional prone outcomes.

Speaker(s): Abouelgreed, MD

Authors: Abouelgreed A.1, Elgendy M2, Abdelaal M.2, Shebl S.2, Sabry K.2, Ibrahim S.2

Institution(s): 1Gulf Medical University, Dept. of Urology, Ajman, United Arab Emirates, 2Alazhar University, Dept. of Urology, Cairo, Egypt

at the #EAU17 - March 24-28, 2017- London, England