Percutaneous Nephrolithotomy

One of the most complex procedures in urology is percutaneous nephrolithotomy. This procedure can be performed in the patient’s prone as well as supine position. The position of the patient during percutaneous nephrolithotomy affects the safety of the procedure, anaesthetic risk, hospitalization time, surgery time, and postoperative complications. The advantages of the supine PCNL are easier patient positioning, shorter surgery time, the possibility of spinal anaesthesia, lower anaesthetic risk in obese patients and patients with high cardiovascular risk, lower risk of injuries to the nervous and musculoskeletal system, and lower risk of infections and sepsis. In the supine PCNL, it is possible to perform simultaneous bilateral endoscopic surgery (SBES) and endoscopic combined intrarenal surgery (ECIRS) as well. The advantages of the prone PCNL are shorter puncture channel, which results in a lower risk of injury to the adjacent organs, the possibility of upper renal calyx puncture, and greater mobility when handling the nephroscope. Although the prone position is used more often today, modern knowledge and clinical experience should encourage us to leave our comfort zone and, considering the patient’s characteristics, critically evaluate whether we will perform the procedure in the supine or prone position.