Comparasion of the results supine – percutaneous nephrolithotomy and prone percutaneous nephrolithotomy

Objective: This study aimed to compare the demographic data, past medical histories, preoperative and postoperative blood values, stone characteristics, complications, hospitalization durations, and surgical efficacy among patients who underwent percutaneous nephrolithotomy based on the operative position. Materıal and Method: This study included 200 patients who underwent percutaneous nephrolithotomy (PNL) operations at the Urology Clinic of İnönü University Turgut Özal Medical Center between 2020 and 2023. Patients were divided into two groups based on the operative position: supine and prone. Each group consisted of 100 patients. Differences between the groups in terms of age, gender, surgical history, additional comorbidities, renal anomalies, stone surface areas, stone locations, ASA score, preoperative DJ stent application, nephrostomy application, hemoglobin, leukocyte, platelet, creatinine levels, development of complications, case duration, scope duration, nephroscope size, need for erythrocyte suspension, presence of postoperative fever, presence of residual stones, need for additional surgical interventions, kidney side information, position information, sheath size, Guy's Stone Scoring, Hounsfield Units, type of PNL, puncture site, and hospitalization duration parameters were retrospectively evaluated. Patients who did not attend follow-up visits during the postoperative period and those whose data could not be accessed were excluded from the study. Fındıngs: When comparing demographic data between groups, no statistical differences were observed in age, gender, additional diseases, ASA scores, and the presence of renal anomalies (p>0.05). However, a significant difference was found in the history of previous surgeries (p<0.05), with a higher rate of previous surgical interventions noted in prone PNL patients. Regarding the comparison of preoperative stone characteristics between groups, no significant differences were observed in terms of Hounsfield Units (p>0.05). However, significant differences were found in stone localization and stone surface area parameters (p<0.05). Significant differences were also detected based on the Guy Stone Score (GSS) classification. In comparing intraoperative and postoperative parameters between groups, significant differences were observed in the use of sheaths, puncture sites, stone localization, and postoperative nephrostomy parameters (p<0.05). There were no significant differences in the rates of preoperative DJ stent application and postoperative DJ stent usage between groups (p>0.05). When comparing preoperative creatinine, leukocyte, and platelet values with their postoperative values between groups, similar changes were observed with no significant differences (p>0.05). However, a significant difference was found in the rate of postoperative hemoglobin decrease (p<0.05). No significant differences were observed between groups in terms of postoperative complication development, presence of residual stones postoperatively, need for blood support due to hemoglobin decrease, and scope duration used in the case (p>0.05). However, significant differences were noted in operation duration and hospitalization duration parameters, favoring supine PNL (p<0.05). Significant parameters identified in the logistic regression model included the history of previous PNL, the number of punctures from the lower pole, stone localization in the middle pole, and postoperative nephrostomy application. Conclusion: Percutaneous nephrolithotomy (PNL) surgery can be safely preferred in both prone and supine positions for stone management. The surgeon's experience plays a crucial role in determining the preferred position. Prone position stands out more in accessing stones and achieving stone clearance, especially in patients with upper pole and middle pole stones. However, supine PNL appears to be more advantageous in terms of hospitalization and operation durations. The ability of the supine position to allow simultaneous endoscopic procedures (ECIRS) seems highly effective in this regard. Complication rates and the frequency of residual stones are similar for both methods, with no superiority observed in terms of surgical success and reliability. Considering the increasing prevalence of cardiac and pulmonary diseases in the population, we believe that supine PNL will become a more prominent and preferred surgical procedure not only in our clinic but also worldwide in the coming years. Key words : supine percutaneus nefrolitotomi, prone percutaneus nefrolitotomi, stone free rate