WCE 2017: Which Position is Best: Prone vs. Supine

Vancouver, Canada (UroToday.com) Dr. Lipkin, associate professor of urologic surgery from Duke University, opened up this plenary session stating that the prone position for percutaneous nephrolithotomy (PCNL) is better. He considers stone free rates, complications, anesthetic concerns, operating room (OR) time and cost. He begins by referencing the CROES study and two recent meta-analyses which showed a higher stone-free rate with the prone position compared to the supine position. However, Dr. Lipkin does agree that the complication rates and anesthetic concerns are equivalent between the two positions. For the OR time, a meta-analysis had shown an 18-minute time saving with the supine position, but one study had shown that when all things are considered the supine PCNL procedure is more costly.

Dr. Vicentini, an associate of the endourology unit from the University of Sao Paulo, and head of the endourology unit at Brigadeiro Hospital begins by stating that the supine position should be favored. He states that one has to try supine to understand, he says “If you are not convinced that supine is better, I guarantee you that if you start doing supine, in few months most of your cases will be done in supine.” Ever since his hospital tried using the supine position in 2014, the rate of prone PCNL is now 0%. He provides evidence that when a hospital begins trying the supine PCNL, it becomes the new standard. He states that the outcomes between prone versus supine PCNL are similar, that supine is feasible and simply easier to do.

Dr. Lipkin argues that the prone position is still superior because retrograde intrarenal surgery can be done at the same time during the PCNL without need for repositioning. In addition, bilateral simultaneous PCNL has been demonstrated to be safe and effective and this can only be done in prone position. Dr. Lipkin reiterates that prone PCNL provides better stone free rates, equivalent complications, but lower costs.

Dr. Vincentini, the proponent of supine PCNL, finishes the debate by stating that there are no differences in complications, the difference in stone-free rates a minor (78% vs 72%), the supine position provides quicker, less bloody, less supracostal punctures and a high success rate even for complicated anatomy or complex cases.

Presented by: Michael Lipkin, Duke University Medical Center;  Fabio Vicentini, University of Sao Paulo & Brigadeiro Hospital

Plenary Chairs: Ben H. Chew, University of British Columbia; Kenneth T. Pace, St. Michael's Hospital, University of Toronto
Session Chair: James Lingeman, Indiana University School of Medicine

Written by Egor Parkhomenko, Department of Urology, University of California-Irvine at the 35th World Congress of Endourology– September 12-16, 2017, Vancouver, Canada.