A Comparison of Postoperative Urological Infection Rates Between Supine and Prone Positions During Percutaneous Nephrolithotomy.

Abstract

Objective: Urological infection is a significant complication following percutaneous nephrolithotomy (PCNL), which can be performed in supine or prone positions, but its impact on infection rates remains debated. This study compares postoperative uro- logical infection rates between supine and prone PCNL and identifies associated risk factors. Methods: A retrospective study was conducted on 290 patients who underwent PCNL between January 2014 and August 2023 in the Thammasat University Hospital. Patients were allocated into 2 groups in a 1 : 2 ratio, with 87 patients in the supine group and 203 patients in the prone group. Statistical analysis included t-tests, Mann-Whitney U tests, Fisher's exact test, and logistic regression models. Results: Postoperative infection rates were significantly lower in the supine group, including fever (33.3% vs. 62.1%, P < .001), UTI (11.5% vs. 32.5%, P < .001), and sepsis (6.9% vs. 17.2%, P = .021). Multivariable analysis identified positive preoperative urine culture (RR 4.41, P < .001) and prone positioning (RR 4.38, P = 0.004) as independent risk factors. The operative time was significantly shorter in the supine group (103.9 ± 42.6 vs. 116.3 ± 38.9 min, P = .016). Stone-free rates and blood loss were comparable, whereas pleural complications were higher in the prone group (6.4% vs. 0%, P = .016). Conclusion: Supine PCNL is associated with significantly lower postoperative infec- tion rates, shorter operative times, and reduced pleural complications compared to the prone position. These findings support supine PCNL as a safer and equally effective alternative management for renal calculi.