Positions for percutaneous nephrolithotomy: Thirty-five years of evolution

Abstract

ObjectivesTo present the chronological development of the different positions described for percutaneous nephrolithotomy (PCNL), in an attempt to identify the reasons for their development and to highlight their specific advantages and disadvantages.MethodsPrevious reports were identified by a non-systematic search of Medline and Scopus.ResultsThe classic prone position for PCNL was first described in 1976. The technique was gradually standardised and PCNL with the patient prone became the generally accepted standard approach. In the next 35 years many other positions were described, with the patient placed prone, lateral or supine in various modifications. Modifications of the classic prone position in the early 1990s aimed to provide the option of a simultaneous retrograde approach during the procedure. As PCNL became more popular the lateral position was first described in 1994, to allow the application of PCNL to patients who were unable to tolerate being prone because of their body habitus. The supine position for percutaneous access was originally described even before 1990, but become more popular after 2007 when the Galdakao modification was reported. Several other modifications of the supine position have been described, with the latest being the flank-free modified supine position, which allows the best exposure of the flank among the supine positions. Each position has its specific advantages and disadvantages.ConclusionUrologists who perform PCNL should be familiar with the differences in the positions and be able to use the method appropriate to each case.

Comparison of the outcomes of complete supine percutaneous nephrolithotomy in patients with radiopaque and radiolucent kidney stones

“…Complete supine PCNL would have a better kidney fluoroscopic view compared to semisupine position because the vertebra would not overlap the fluoroscopic view. [6,7] Stone composition has been used to anticipate the success rate of ESWL. However, it has been found that the stone construction is more important than its composition.…”

Comparision of hemodynamic changes, movement, duration of surgery and pain between lateral and supine posision after spinal anesthesia in transurethral lithotrips

“…For example, patients with staghorn calculi and obese patients develop fewer complications at supine position (25). In addition, other studies indicated that urologists should select the type of position according to the patient's conditions (20,23). In this study, in TUL the patients' blood pressure was more stable at lateral position and therefore this position can be considered a suitable position for patients undergoing spinal anesthesia.…”

“…Lateral and supine positions are considered safe positions in kidney surgeries and therefore recommended for patients at high risk (15,22). The patients feel more comfortable in these positions that are generally convenient and low-risk positions (23). However, the findings of a review of supine and prone positions in percutaneous nephrolithotomy showed that controversies over the type of position remain with no difference between these two positions (24).…”

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“…2 Currently, the European Association of Urology (EAU) clinical guidelines panel recommends percutaneous nephrolithotomy as the first-line treatment for kidney stones measuring 2 cm, lower pole stones of 1.5 cm, and staghorn stones. [3][4][5] It has almost completely replaced open surgery, because it is less invasive, safer, and more effective (stone-free rates of 78 to 95%). 6 Traditionally, the prone position was exclusively considered for renal access.…”