Supine versus prone position for percutaneous nephrolithotripsy: A meta-analysis of randomized controlled trials

Li, Jie; Gao, Liang; Li, Qiubo; Zhang, Yuanfeng; Jiang, Qing

doi:10.1016/j.ijsu.2019.04.016

Cited by 69 publications

(38 citation statements)

References 29 publications

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“…In a meta-analysis of 15 RCTs with a total of 1474 patients, Lie et al compared supine versus prone position in PCNL and found that operative time in supine PCNL was shorter [48]. As also mentioned above, Lie and colleagues noted that the downward or horizontal angle of the Amplatz sheath facilitated faster evacuation of stone fragments with the help of gravity.…”

Section: Lithotripsy and Stone Clearance In Supine Pcnlmentioning

confidence: 98%

Consultation on kidney stones, Copenhagen 2019: lithotripsy in percutaneous nephrolithotomy

Axelsson

Cracco²,

Desai

et al. 2020

World J Urol

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Purpose To evaluate the balance between existing evidence and expert opinions on the safety and efficacy of new technological improvements in lithotripsy techniques for percutaneous nephrolithotomy (PCNL). Methods A scoping review approach was applied to search literature in Pubmed, Embase, and Web of Science. Consensus by key opinion leaders was reached at a 2-day meeting entitled "Consultation on Kidney Stones: Aspects of Intracorporeal Lithotripsy" held in Copenhagen, Denmark, in September 2019. Results New-generation dual-mode single-probe lithotripsy devices have shown favourable results compared with use of ballistic or ultrasonic lithotripters only. However, ballistic and ultrasonic lithotripters are also highly effective and safe and have been the backbone of PCNL for many years. Compared with standard PCNL, it seems that mini PCNL is associated with fewer bleeding complications and shorter hospital admissions, but also with longer operating room (OR) time and higher intrarenal pressure. Use of laser lithotripsy combined with suction in mini PCNL is a promising alternative that may improve such PCNL by shortening OR times. Furthermore, supine PCNL is a good alternative, especially in cases with complex renal stones and large proximal ureteric stones; in addition, it facilitates endoscopic combined intrarenal surgery (ECIRS). Conclusion Recent technological improvements in PCNL techniques are promising, but there is a lack of high-level evidence on safety and efficacy. Different techniques suit different types of stones and patients. The evolution of diverse methods has given urologists the possibility of a personalized stone approach, in other words, the right approach for the right patient.

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Section: Lithotripsy and Stone Clearance In Supine Pcnlmentioning

confidence: 98%

Consultation on kidney stones, Copenhagen 2019: lithotripsy in percutaneous nephrolithotomy

Axelsson

Cracco²,

Desai

et al. 2020

World J Urol

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“…Although prone position was preferred in PCNL at first, over the years, supine or modified supine techniques have started to gain popularity [5,[9][10][11][12]. In two major meta-analyzes; pooled data showed that PCNL in supine position could significantly reduce the operative time compared to the prone position [15,16]. Studies have reported similar stone-free rates, hospitalization, and complication rates in both positions [15].…”

Section: Discussionmentioning

confidence: 99%

“…In two major meta-analyzes; pooled data showed that PCNL in supine position could significantly reduce the operative time compared to the prone position [15,16]. Studies have reported similar stone-free rates, hospitalization, and complication rates in both positions [15].…”

Section: Discussionmentioning

confidence: 99%

Prone versus Barts “flank-free” modified supine percutaneous nephrolithotomy: a match-pair analysis

Miçooğulları¹,

Kamaci²,

Yıldızhan³

et al. 2021

Turk J Med Sci

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Background/aim: In this study, we aimed to compare the results of prone and Barts "flank-free" modified supine percutaneous nephrolithotomy (PCNL) operations in our clinic. Materials and methods:The data from patients that underwent Barts "flank-free" modified supine PCNL (BS-PCNL) (n=52) between June 2018 and July 2020 and prone PCNL (P-PCNL) (n=286) between April 2014 and June 2018 were retrospectively evaluated. Of those 286 patients, 104 patients whose gender, age, body mass index, American Society of Anesthesiology score, stone localization, stone size, and hydronephrosis matched the BS-PCNL group in a 1:2 ratio were included in the study.The groups were compared in terms of intraoperative outcome, complication rates, and stone-free rates. Results:The mean age of all patients (58 females, 98 males) included in the study was 41.8±15.2 years, and the mean body mass index (BMI) was 24.7±2.9 kg/m 2 . The mean operation time was significantly shorter in the BS-PCNL group than in the P-PCNL group (80.2±15.1 min vs. 92.4±22.7 min and p=0.01). There was no significant difference between the two groups in terms of fluoroscopy time, intraoperative complications, postoperative complications, and stone-free rates. Conclusions:Our study shows that BS-PCNL is an effective and safe method that significantly reduces the operation time and should be considered as one of the primary treatment options for patients scheduled for PCNL.

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“…19 Using this position, turning the patient prone is unnecessary; therefore, the total operative time may be reduced. 8 This position has even been used for complex cases, showing similar efficacy. 20 One group used to performing PCNL in the supine position, when faced with HSK, probably tended toward using that position.…”

Section: Percutaneous Nephrolithotomy In Horseshoe Kidneys 981mentioning

confidence: 96%

“…6,7 In patients with HSK, this is usually performed in the prone position, allowing entry through the upper pole and providing good access to the collecting system. However, in patients with normal kidney anatomy, the supine position is reliable and safe in most cases, 8 but it is unknown whether the supine position is adequate in patients with HSK. Access through the upper pole is not usually preferred during supine PCNL, 9 and some researchers fear it could compromise outcomes.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Nephrolithotomy in Horseshoe Kidneys: Results of a Multicentric Study

Vicentini

Mazzucchi

Gökçe

et al. 2021

Journal of Endourology

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Objective: To report the outcomes of percutaneous nephrolithotomy (PCNL) in horseshoe kidneys (HSK) in 12 institutions worldwide and evaluate the impact of patient position during operation. Methods: We carried out a retrospective analysis of PCNL procedures performed between 2008 and 2018 in patients with HSK. Pre-, peri-, and postoperative data were collected, and a subgroup analysis was performed according to patient position. Success was defined as an absence of >4-mm fragments. Values of p < 0.05 were considered significant. Results: We analyzed 106 procedures. The transfusion, complication, and immediate success rates (ISRs) were 3.8%, 17.5%, and 54.7%, respectively. The final success rate (FSR) increased to 72.4% after a mean of 0.24 secondary procedures. Logistic regression showed that higher body mass index (BMI) and stone size were significantly associated with residual fragments ‡4 mm. Sixty-seven patients (63.2%) were treated in prone and 39 (36.8%) in supine position. The prone group had a significantly higher BMI than the supine group (30.1 vs 27.7, p = 0.024). The transfusion, complication, and ISRs between the prone and supine groups were 4.5% vs 2.6% ( p = 0.99), 16.9% vs 18.4% ( p = 0.99), and 52.5% vs 69.2% ( p = 0.151), respectively. Surgical time was significantly longer in the prone group (126.5 vs 100 minutes, p = 0.04). Upper pole was the preferred access in 80.3% of the prone group and 43.6% of the supine group ( p < 0.001). The prone group had significantly more Clavien 2 complications than the supine ( p = 0.013). The FSR in the prone and supine groups increased to 66.1% and 82.1% after 0.26 and 0.21 secondary procedures, respectively. No complications higher than Clavien 3 occurred. Conclusion: PCNL in patients with HSK is safe and effective with a low complication rate. Higher BMI and stone size negatively impacted outcomes. Supine PCNL may be an option for treating kidney stones in patients with HSK.

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Supine versus prone position for percutaneous nephrolithotripsy: A meta-analysis of randomized controlled trials

Cited by 69 publications

References 29 publications

Consultation on kidney stones, Copenhagen 2019: lithotripsy in percutaneous nephrolithotomy

Consultation on kidney stones, Copenhagen 2019: lithotripsy in percutaneous nephrolithotomy

Prone versus Barts “flank-free” modified supine percutaneous nephrolithotomy: a match-pair analysis

Percutaneous Nephrolithotomy in Horseshoe Kidneys: Results of a Multicentric Study

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