The optimal patient position for percutaneous nephrolithotomy (PCNL) remains a matter of debate. Our aim was to evaluate the association between prone versus supine positioning and perioperative and postoperative outcomes of suction mini-PCNL.
In this prospective multicenter observational study, we analyzed data for 1534 patients treated in 30 centers between March and November 2024. Outcomes included the stone-free rate (SFR) assessed via 30-d computed tomography, and complication rates. Multivariable analysis was used to assess the effect of prone positioning on stone-free status (zero fragments) and overall complications, with adjustment for other covariates.
There were 653 patients (43%) in the prone group and 881 (57%) in the supine group. Patient demographics were similar between the groups, except for body mass index. In terms of Guy's stone score, the prone group had a higher proportion of score 1 stones (60% vs 47%) and the supine group a higher proportion of score 4 stones (6.9% vs 3.2%). Median stone volume did not differ significantly, at 1636 mm3 in the supine group and 1725 mm3 in the prone group (p = 0.7). The prone group had more frequent use of spinal anesthesia (68% vs 29%; p < 0.001), fluoroscopy-only guidance (86% vs 61%; p < 0.001), and supracostal access (36% vs 22%; p < 0.001). Surgical time, pain scores, hospital length of stay, and readmission rates were similar between the groups. Zero-fragment stone-free rates were comparable (85% prone vs 81% supine; p = 0.052). Prone position was associated with higher rates of blood transfusion (2.8% vs 0%; p < 0.001), renal pelvic perforation (2.8% vs 0.23%; p < 0.001), and pneumothorax (1.5% vs 0%; p < 0.001). Multivariable analysis revealed that prone positioning was not significantly associated with grade A stone-free status (odds ratio 0.92, 95% confidence interval [CI] 0.66-1.29; p = 0.6) or the overall complication rate (odd ratio 0.87, 95% CI 0.59-1.28; p = 0.5). The nonrandomized study design may have introduced selection bias and limited our ability to establish causal relationships between variables.
Both prone and supine positioning for PCNL achieved excellent SFRs with acceptable safety profiles.
European urology focus. 2025 Oct 29 [Epub ahead of print]
Daniele Castellani, Vineet Gauhar, Jaisukh Kalathia, Amish Mehta, Nariman Gadzhiev, Vigen Malkhasyan, Nitesh Kumar, Rajiv H Kalbit, Ivan Gorgotsky, Mehmet Ilker Gokce, Mahmoud Laymon, Takaaki Inoue, Gopal Ramdas Tak, Abu Baker, Pankaj Dholaria, Arun Chawla, Edgar Beltrán-Suárez, Abhay Mahajan, Khi Yung Fong, Steffi Kar-Kei Yuen, Karl Tan, Mohamed Omar, Kremena Petkova, Kazumi Taguchi, Chinnakhet Ketsuwan, Mohamed Amine Lakmichi, Sundaram Palaniappan, Yiloren Tanidir, Nebil Akdogan, Marcos Cepeda, Alexey Martov, Zelimkhan Tokhtiyev, Lazaros Tzelves, Andreas Skolarikos, Esteban Acuña, Marek Zawadzki, Wissam Kamal, Leonardo Gomes Lopes, Dmitriy Gorelov, Madhu Sudan Agrawal, Vaddi Chandra Mohan, Thomas R W Herrmann, Bhaskar K Somani
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