Objective: To compare operative time, safety and effectiveness of minimally invasive percutaneous nephrolithotomy (MPCNL) in the supine lithotomy versus prone position. Methods: Between January 2008 and December 2010, a total of 109 consecutive patients with upper urinary tract calculi were enrolled and randomly divided into group A (53 patients, supine lithotomy position) and group B (56 patients, prone position). The MPCNL procedures were performed under the guidance of real-time grayscale ultrasound system. The preoperative characteristics, intraoperative and postoperative parameters were analyzed and compared. Results: All patients were successfully operated. There was no significant difference between the two groups in stone-free rate (group A 90.1 vs. group B 87.5%, p = 0.45), mean blood loss, number of access tracts, calyx puncture, mean hospital stay (group A 6 ± 1.1 vs. group B 6 ± 1.5 days, p = 0.38) and complications. But the operative time was significantly shortened in supine lithotomy position (group A 56 ± 15 vs. group B 86 ± 23 min, p < 0.001). Conclusions: The effectiveness and safety of the supine lithotomy position for MPCNL were similar to the prone position. However, the supine lithotomy position has an important advantage of reducing the operative time. The supine lithotomy position could be a good choice to perform MPCNL.

1.
Preminger GM, Assimos DG, Lingeman JE, Nakada SY, Pearle MS, Wolf JS Jr: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol 2005;173:1991-2000.
2.
Fernström I, Johansson B: Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol 1976;10:257-259.
3.
Shoma AM, Eraky I, El-Kenawy MR, El-Kappany HA: Percutaneous nephrolithotomy in the supine position: technical aspects and functional outcome compared with the prone technique. Urology 2002;60:388-392.
4.
Walick KS, Kragh JE Jr, Ward JA, Crawford JJ: Changes in intraocular pressure due to surgical positioning: studying potential risk for postoperative vision loss. Spine (Pa.) 2007;32:2591-2595.
5.
Valdivia Uría JG, Valle Gerhold J, López López JA, Villarroya Rodriguez S, Ambroj Navarro C, Ramirez Fabián M, Rodriguez Bazalo JM, Sánchez Elipe MA: Technique and complications of percutaneous nephroscopy: experience with 557 patients in the supine position. J Urol 1998;160:1975-1978.
6.
Ibarluzea G, Scoffone CM, Cracco CM, Poggio M, Porpiglia F, Terrone C, Astobieta A, Camargo I, Gamarra M, Tempia A, Valdivia Uria JG, Scarpa RM: Supine valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access. BJU Int 2007;100:233-236.
7.
De Sio M, Autorino R, Quarto G, Calabrò F, Damiano R, Giugliano F, Mordente S, D'Armiento M: Modified supine versus prone position in percutaneous nephrolithotomy for renal stones treatable with a single percutaneous access: a prospective randomized trial. Eur Urol 2008;54:196-202.
8.
Scoffone CM, Cracco CM, Cossu M, Grande S, Poggio M, Scarpa RM: Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: a new standard forpercutaneous nephrolithotomy? Eur Urol 2008;54:1393-1403.
9.
Bach C, Goyal A, Kumar P, Kachrilas S, Papatsoris AG, Buchholz N, Masood J: The Barts ‘flank-free' modified supine position for percutaneous nephrolithotomy. Urol Int 2012;89:365-368.
10.
Jackman SV, Docimo SG, Cadeddu JA, Bishoff JT, Kavoussi LR, Jarrett TW: The ‘mini-perc' technique: a less invasive alternative to percutaneous nephrolithotomy. World J Urol 1998;16:371-374.
11.
Zhou X, Gao X, Wen J, Xiao C: Clinical value of minimally invasive percutaneous nephrolithotomy in the supine position under the guidance of real-time ultrasound: report of 92 cases. Urol Res 2008;36:111-114.
12.
Miano R, Scoffone C, De Nunzio C, Germani S, Cracco C, Usai P, Tubaro A, Kim FJ, Micali S: Position: prone or supine is the issue of percutaneous nephrolithotomy. J Endourol 2010;24:931-938.
13.
Gofrit ON, Shapiro A, Donchin Y, Bloom AI, Shenfeld OZ, Landau EH, Pode D: Lateral decubitus position for percutaneous nephrolithotripsy in the morbidly obese or kyphotic patient. J Endourol 2002;16:383-386.
14.
Falahatkar S, Enshaei A, Afsharimoghaddam A, Emadi SA, Allahkhah AA: Complete supine percutaneous nephrolithotomy with lung inflation avoids the need for a supracostal puncture. J Endourol 2010;24:213-218.
15.
Wang Y, Jiang F, Wang Y, Hou Y, Zhang H, Chen Q, Xu N, Lu Z, Hu J, Lu J, Wang X, Hao Y, Wang C: Post-percutaneous nephrolithotomy septic shock and severe hemorrhage: a study of risk factors. Urol Int 2012;88:307-310.
16.
Manohar T, Jain P, Desai M: Supine percutaneous nephrolithotomy: effective approach to high-risk and morbidly obese patients. J Endourol 2007;21:44-49.
17.
Marguet CG, Springhart WP, Tan YH, Patel A, Undre S, Albala DM, Preminger GM: Simultaneous combined use of flexible ureteroscopy and percutaneous nephrolithotomy to reduce the number of access tracts in the management of complex renal calculi. BJU Int 2005;96:1097-1100.
18.
Michel MS, Trojan L, Rassweiler JJ: Complications in percutaneous nephrolithotomy. Eur Urol 2007;51:899-906.
19.
Lu MH, Pu XY, Gao X, Zhou XF, Qiu JG, Si-Tu J: A comparative study of clinical value of single B-mode ultrasound guidance and B-mode combined with color doppler ultrasound guidance in mini-invasive percutaneous nephrolithotomy to decrease hemorrhagic complications. Urology 2010;76:815-820.
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