WCE 2019: Supine Percutaneous Nephrolithotomy in Horseshoe Kidneys? Results of Multicentric Study

Abu Dhabi, United Arab Emirates (UroToday.com) Dr. Fabio Vicentini discussed the findings of his international multicenter, retrospective study that looked at the positioning of patients with horseshoe kidneys who underwent PCNL. To date, there have been no data comparing the prone versus supine positions. Prone positions have been typically employed due to cultural reasons.

Dr. Vicentini collaborated with 11 other international tertiary urological centers to analyze a total of 106 cases of PCNL in horseshoe kidney patients, 39 of which were supine and 67 of which were prone. In particular, Dr. Vicentini was interested in reporting the surgical outcomes, with success of the PCNL defined as the absence of greater than 4 mm stone fragments on postoperative imaging.

Dr. Vicentini found that the immediate success rate of PCNL was 52.5% and 69.2% for prone and supine positions, respectively, though this difference was not statistically different. However, after secondary procedures, the final success rate was 66.1% and 82.1% for prone and supine positions, respectively (p = 0.09). Additionally, operative time was significantly higher in the prone cohort at 126.5 minutes compared to 100 minutes for the supine cohort (p = 0.04). There was no statistical difference in transfusions or complication rates.

In conclusion, Dr. Vicentini and his colleagues demonstrated that a supine position may be as good as prone position for PCNL in horseshoe kidney patients. This finding may lead to a paradigm shift in the practice of urology.

Presented by: Fabio Vicentini, MD, PhD, Head of Endourology Unit, University of Sao Paulo Medical School, Sao Paolo, Brazil

Written by: Lillian Xie, BA, Department of Urology, University of California, Irvine, California at the 37th World Congress of Endourology (WCE) – October 29th-November 2nd, Abu Dhabi, United Arab Emirates