Prospective Comparative Analysis of Supine Versus Prone Percutaneous Nephrolithotomy in Patients with Complex Renal Stone Disease and Difficult Anatomy.

Objective:  In complex renal stone disease, few studies have shown that supine percutaneous nephrolithotomy (PCNL) is not inferior to prone PCNL. In our study, we evaluated the safety and efficacy of supine versus prone PCNL in patients with complex renal stone disease and patients with difficult anatomy.

Methods:  We prospectively analyzed 106 patients over 15 months from October 2022 to December 2023 and divided them as group S (Calcutta position supine arm) and group P (classical prone arm) by simple randomization. The measured data included body mass index (BMI), stone size, location of stone, number of punctures/ access, tract length, bleeding, operative time, stone-free rate (SFR), length of hospital stay, and postoperative complications.

Results:  The operative time was 104.722 ± (34.48) versus 124.30 ± (22.67) minutes (group S vs. group P), which was significant (P=.01). The nephroscopy time was 89.722 ± 34.55 in group S vs. 92.212 ± 20.18 minutes, which was also significant (P = .01). The mean postoperative hospital stay was 3.889 ± 1.09 and 4.558 ± 1.33 days in supine and prone group (P = .021), respectively. Four patients in group S required re-look PCNL in comparison to 8 in group P. Overall SFR at 1 month was 76.92% and 68.51% (P .331), respectively in case of group S and P.

Conclusion:  The study revealed that supine position in Calcutta position is a viable alternative to classical prone position even in patients with complex renal stone and patients with difficult anatomy as major complications are less, SFR is higher, and need of auxiliary procedures are rare.