A comparative analysis of the efficacy and safety of mini-percutaneous nephrolithotomy performed in the supine and prone positions for the treatment of pediatric kidney stones: a single-center experience

Abstract

AimMini-percutaneous nephrolithotomy (MPCNL), which has a smaller tract size (14-20 Fr) than conventional percutaneous nephrolithotomy, has been shown to be safe and effective in pediatric patients with large and complex upper urinary tract stones. This study aimed to compare the e cacy and safety of MPCNL between the supine and prone positions in a pediatric population. MethodThe data of pediatric patients who underwent MPCNL at our center between January 2010 and March 2023 were retrospectively analyzed. According to the surgical position, the patients were divided into the prone (Group P) and supine (Group S) groups. In both groups, dilatation was performed using 14-18Fr metallic dilators. The two groups were compared in terms of perioperative data, postoperative stone-free rates (SFRs), and complications. ResultsThere were 36 (59%) patients in Group P and 25 (41%) patients in Group S. Stones were mostly located in the pelvis (49.2%) and second most frequently in the lower pole (27.9%). Fluoroscopy time was shorter in Group S but did not statistically signi cantly differ compared to Group P (p = 0.181). However, operation time was statistically signi cantly shorter in Group S (73.8 ± 35 vs. 99.8 ± 37.4 min, p = 0.008). Although there was no signi cant difference, relatively higher SFR were detected in Group S (88% vs. 83%, p = 0.725). Endoscopic combined intrarenal surgery (ECIRS) was performed on six (24%) patients in Group S, and the SFR was 100% among these patients. There was no signi cant difference between the two groups in terms of the presence of complications (16.7% vs. 16%, p = 0.945). ConclusionBoth supine and prone MPCNL appear to be safe and effective in the pediatric age group, with similar stone-free and complication rates. In the supine procedure, the operation time is shortened compared to the prone. In addition, simultaneous retrograde access has the potential to increase the overall success rate of surgery.

Comparison of safety and efficacy of different positions in percutaneous nephrolithotomy: a network meta-analysis

“…Additionally, Valdivia-Uria and colleagues described a lateral approach to perform PCNL in the supine position in 1998 6 . The supine position is gradually gaining prominence due to the advantages it offers in Endoscopic Combined Intrarenal Surgery (ECIRS) and under general anesthesia, challenging the conventional prone position 7 . In 2011, Lezrek’s team introduced the split-leg position 8 .…”