Radiologic imaging with CT scan shows significant changes in the positioning of adjacent organs, such as liver, spleen and colon when the patient is in the prone versus supping position. These researchers suggested a greater risk, in the prone position, of transpleural puncture on either side and possibly greater risk of transcolonic puncture during left lower pole access. However, the International Cooperation in Endourology compared supine versus prone PCNL in 350 obese patients and found high success rates for both approaches and clinically similar and low complication rates.
So while theoretically one positioning may have advantages or disadvantages for PCNL, in reality it would appear that with adequate training and experience both the supine and prone PCNL are equivalent in rendering the patient stone free and with minimal operative complications.
Presented by Brian Eisner, et al. at the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA
Reported for UroToday by Elspeth M. McDougall, MD, FRCSC, Professor of Urology/Director, Surgical Education Institute at the University of California, Irvine.