In a nice report by Brian Duty and colleagues, computed tomography was performed on patients in the prone, supine and supine oblique positions. The mean nephrostomy tract length was significantly shorter for the prone versus supine for both the right and left kidneys (82.6mm and 85.4mm vs. 108.3mm and 103.7mm vs. 86.1mm) and the prone vs. oblique supine position (86.1mm vs. 96.5mm). The clinical significance of these findings, however, is questionable.
Zhan Hailun and colleagues found no difference in stone-free rates, blood loss, number of access tracts, hospital stay, or complication rates between the supine and prone positions. Interestingly they did note shorter operative times in the supine position (56 vs. 86 min, p<0.001). Similarly, Roberto Peschechera and colleagues also found shorter operative times (85min vs. 128min, p<0,001), higher tubeless rates (71% vs. 53%, p<0.001) and fewer second looks (4.8% vs 17%, p<0.001) in the supine vs. prone groups. While much of the time saved is likely from patient re-positioning (although not specified in the abstracts), the supine position is certainly compelling for its lower second look rates and higher tubeless rates. Prospective, randomized trials would likely aid in defining the role of the prone and supine positions.
Also:
Supine-lithotomy versus prone position in minimally invasive percutaneous nephrolithotomy for upper urinary tract calculi
by Zhan Hailun
and
PCNL: Prone or Supine?by Roberto Peschechera
Presented by Brian Duty at the 29th World Congress of Endourology & SWL (WCE) - November 30 - December 3, 2011 - Kyoto International Conference Center - Kyoto, Japan
Reported for UroToday by Joseph Graversen, Fellow Minimally Invasive Surgery and Endourology, University of California-Irvine Medical Center, Irvine, CA
View Full WCE 2011 Meeting Coverage
