What is one step ahead in percutaneous nephrolithotomy - Prone or supine? A review

Percutaneous nephrolithotomy (PCNL) is an adopted of ongoing debate and is commonly performed in the prone position, as it provides access to the collecting system. The supine position has a low impact on circulation and the pulmonary system. This makes it helpful to monitor and in turn, may reduce the dose of anesthetics and is quite useful in pediatric, geriatric, obese/overweight, and spinal deformity patients, and those who are debilitated. Our comprehensive review, covering literature from 2012 to 2023, scrutinized systematic reviews, meta-analyses, and prospective and retrospective cohort studies. The technique's two positions were compared concerning mean hospital stay, complication rates, operating time, analgesic requirements, and patient characteristics such as comorbidity status or mean BMI. We found no difference in terms of stone-free rates, radiation exposure, or procedural duration. Whereas patients with elevated mean BMI, requiring less analgesia, operating time, and hospital stay may benefit from the supine position. Supine takes an edge on patients with comorbidities, exhibiting a lower incidence of postoperative fever and reduced need for blood transfusions. Patient-specific factors must be considered while selecting the optimal renal access position.