Is A Modified Supine Nephrolithotomy Better Than Prone Percutaneous Nephrolithotomy?

Background: Percutaneous nephrolithotomy [PCNL] is the gold standard surgical procedure for treating large, complex renal stones. The ultimate PCNL positioning is debatable. As a result, research on the influence of patient posture on PCNL outcomes is required.The aim of the work: This study aimed to compare the surgical outcome of PCNLs performed using modified supine positions [MSP] with the standard prone position [PP].Patients and Methods: This prospective, non-randomized study included 350 PCNL patients, 150 in the PP group and 200 in the MSP group. We included patients with urinary stones who came to the Urology Department, Al-Azhar University, Damietta, Egypt, for PCNL, during the period from January 2017 to December 2020.Results: The mean operative time of the studied patients was 120.8±32.6 and 91.7±35.4 min in PP and MSP groups, respectively [P=0.001]. The mean hospital stay was significantly [P=0.003] longer in the PP group [3.0±2.5 days] than in the MSP group [2.0±2.1 days]. Both groups have a comparable rate [MPS: 82% vs. PP 80%; P=0.856] in terms of stone-free rate. The mean heart rate was higher [p=0.002] in the PP group [96.8±12.6 bpm] than in the MSP group [72.6±11.9 bpm]. Regarding operative complications, the overall complication rate was higher in the PP [11.33%] than in the MSP group [6%]; however, there is no statistically significant difference [p=0.073].Conclusion: The current findings demonstrated that MSP had a shorter operative time and shorter hospital stays. Both groups showed a comparable stone-free rate and postoperative complications.