WCE 2018: Where’s the Evidence? Supine Percutaneous Nephrolithotomy

Paris, France (UroToday.com) Dr. Gutierrez-Aceves shed light on the contentious topic of patient positioning during percutaneous nephrolithotomy (PCNL). The talk centered around prone positioning versus modified supine positioning; the latter is depicted in the image below (Figure 1).


UroToday WCE2018 Modified supine positioning for PCNL
Figure 1. Modified supine positioning for PCNL

After leading with a broad discussion about both types of positioning methods, he presented data from recent studies. One study indicated that hemodynamic variables (e.g. heart rate) may be better managed when using supine positioning. Additionally, analysis of the Clinical Research Office of the Endourological Society (CROES) database shows that, in 2010, approximately 80% of urologists used prone positioning during PCNL, and a better stone-free rate was achieved when using prone positioning, which Dr.  Gutierrez-Aceves stated is likely due to easier access to the upper pole. However, a more recent paper reported that supine positioning is associated with decreased surgical time compared to prone. A summary of the advantages and disadvantages associated with each positioning method is pictured below (Figure 2).

UroToday WCE2018 Summary of advantages of supine vs. prone positioning in PCNL UroToday WCE2018 Summary of disadvantages of supine vs. prone positioning in PCNL
Figure 2. Summary of advantages (top) and disadvantages (bottom) of supine vs. prone positioning in PCNL 

So, generally speaking, does supine versus prone positioning during PCNL really matter? Ultimately, Dr. Gutierrez-Aceves concluded that the answer is, “No.” There is no data that indicates the clear superiority of one over the other, and the decision for positioning should be made based on the preference of the surgeon and the surgical team. As the moderator chimed in at the end of the talk, “It is the driver, not the car.” 


Presented by: Jorge Gutierrez-Aceves, MD, Wake Forest Baptist Health