Comparison of the Prone Split-Leg Position with the Traditional Prone Position in Percutaneous Nephrolithotomy: A Propensity Score-Matching Study

Abstract

Background and Objective: Several positions have been described for percutaneous nephrolithotomy (PCNL). The aim of this study was to compare the safety and effectiveness of the traditional prone position PCNL (TP-PCNL) and the prone split-leg position PCNL (PSL-PCNL). Patients and Methods: A retrospective review was made of the data of 212 patients who underwent prone PCNL in PSL or TP between January 2017 and November 2019. The demographic and preoperative clinical data were used for propensity score-matching (PSM). Following the PSM based on a multivariable logistic regression model, the PSL-PCNL and TP-PCNL groups were compared in preoperative, perioperative, and postoperative parameters. All surgical procedures were performed by an experienced endourologist. Results: After PSM, 51 patients from the PSL-PCNL group were matched to 51 TP-PCNL patients. The stone burden was not statistically significant between the two groups ( p = 0.388). The mean operation time of the two groups was significantly different (81.5 -32.4 minutes vs 93.1 -25.9 minutes, respectively, p = 0.026). The hemoglobin decrease in the PSL-PCNL group was greater than that in the TP-PCNL group (-17.7 -16.9 g/L vs 13.1 -10.9 g/L, p < 0.001). Both groups had similar stone-free rates after 2 weeks ( p = 0.49). No significant difference was observed between the groups in the total complication rate ( p = 1). Conclusions: The application of PSL in PCNL simplifies the surgical procedure and shortens the operating time. Another important advantage is that it allows retrograde intrarenal surgery and ureteroscopy to be performed simultaneously. We recommend the PSL to be applied in PCNL for renal stone patients.

Contralateral knee-flexion prone split-leg percutaneous nephrolithotomy: A versatile technique

“…Actually, the real-time savings came from the pre-lithotripsy time, which can be attributed to patients' repositioning, re-prepping, and re-draping as well as surgeons' re-scrubbing and gowning. Flipping-over patients into the TP position after induction of anesthesia consumes time and effort and has some potential for complications, which is unwelcome to both Anesthesiologists and Urologists (3,8,23), it might be risky for patients with respiratory or cardiac problems and markedly obese patients. Another time-saving factor of the pre-lithotripsy time was that retrograde URS uretericatheterization and anterograde percutaneous renal puncture could usually be performed simultaneously.…”

“…Percutaneous nephrolithotomy (PCNL) has become the main technique and is often recommended for patients with calculus > 2 cm, especially those with staghorn renal stones (1,2). Many safe and effective changes in patient positioning for PCNL have been proposed over the years, including the traditional prone position(TP), prone split-leg position(PSL) (3,4), lateral decubitus (5) and supine position(SP)(6). However, the optimal position remains controversial.…”

“…However, this approach has several drawbacks. The change in position in this method in uences the effectiveness and safety of the surgery (3). In some cases, endoscopic combined intrarenal surgery (ECIRS) using retrograde ureteroscopy (URS) and PCNL is needed as a one-step treatment that reduces the need for both multiple access and secondary procedures (9).…”

Endoscopic combined intrarenal surgery in prone split-leg and inclined supine positions to treat renal cast and multiple calyx stones: An invited commentary

“…[3] Multichannel lithotripsy and endoscopic combined intrarenal surgery (ECIRS) in prone split-leg and inclined supine positions can improve the stone clearance rate. [4] The 2016 American Urological Association guidelines established multi-channel PCNL as a safe and effective treatment for complex stones. In a previous study, the stone-free rate in a single operation was 79%, but the size and number of channels increased, followed by an increased risk of bleeding.…”