International Urology and Nephrology

, Volume 43, Issue 1, pp 67–77 | Cite as

Supine versus prone position in percutaneous nephrolithotomy for kidney calculi: a meta-analysis

  • Peng Wu
  • Li Wang
  • Kunjie Wang
Urology – Original Paper



Supine position and prone position were the choice for percutaneous nephrolithotomy (PCNL). However, there is still no consensus on the optimal position for PCNL.


A systematic literature review was performed, searching Pubmed, Embase, CENTRAL and reference lists for relevant studies. Data from all selected articles were extracted independently by two reviewers and analyzed by RevMan 5 software.


Four comparative studies involving 389 cases and 27 case series studies including 1,469 renal units of supine position and 4,837 renal units of prone position were identified. With reference to comparative studies, the mean stone length and the proportions of staghorn and multiple stones were comparable between two positions. There was no significant difference in terms of stone-free rate (risk ratio = 1.00, 95% confidence interval: 0.92 to 1.09; 82.4 vs. 82.1%) and bleeding. The rate of colonic injury in supine PCNL was approximate 0.5% and incidence of pleural injury of 0% was noted for both positions. Pelvic perforation and failed access were comparable between supine and prone position. The operative times of supine position significantly decreased (65±15 vs. 90±15 min; mean difference = −24.76, 95% confidence interval: −39.36 to −10.15), but no significant difference was found in mean days hospital stay. Analysis based on the case series showed larger proportion of staghorn and multiple calculi in prone position (45.8 vs. 31.7%), the supine PCNL had slightly lower bleeding and similar stone-free rate compared with the prone position.


For general patients with kidney calculi, PCNL in supine position has similar stone-free rate compared with prone. Supine PCNL do not increase related complications. The operative times significantly decrease in supine position.


Kidney calculi Meta-analysis Nephrostomy percutaneous Prone position Supine position 



No financial support was obtained from any institution or company except for logistic support from the authors’ affiliation departments.


  1. 1.
    Goodwin WE, Casey WC, Woolf W (1955) Percutaneous trocar (needle) nephrostomy in hydronephrosis. J Am Med Assoc 157:891–894PubMedGoogle Scholar
  2. 2.
    Fernstrom I, Johansson B (1976) Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol 10:257–259PubMedGoogle Scholar
  3. 3.
    Valdivia Uria JG, Valle Gerhold J, Lopez Lopez JA et al (1998) Technique and complications of percutaneous nephroscopy: experience with 557 patients in the supine position. J Urol 160:1975–1978PubMedCrossRefGoogle Scholar
  4. 4.
    De Sio M, Autorino R, Quarto G et al (2008) Modified supine versus prone position in percutaneous nephrolithotomy for renal stones treatable with a single percutaneous access: a prospective randomized trial. Eur Urol 54:196–202PubMedCrossRefGoogle Scholar
  5. 5.
    Falahatkar S, Moghaddam AA, Salehi M et al (2008) Complete supine percutaneous nephrolithotripsy comparison with the prone standard technique. J Endourol 22:2513–2517PubMedCrossRefGoogle Scholar
  6. 6.
    Shoma AM, Eraky I, El-Kenawy MR et al (2002) Percutaneous nephrolithotomy in the supine position: technical aspects and functional outcome compared with the prone technique. Urology 60:388–392PubMedCrossRefGoogle Scholar
  7. 7.
    Amon Sesmero JH, Del Valle Gonzalez N, Conde Redondo C et al (2008) Comparison between Valdivia position and prone position in percutaneous nephrolithotomy. Actas Urol Esp 32:424–429PubMedCrossRefGoogle Scholar
  8. 8.
    Steele D, Marshall V (2007) Percutaneous nephrolithotomy in the supine position: a neglected approach? J Endourol 21:1433–1437PubMedCrossRefGoogle Scholar
  9. 9.
    Zhou X, Gao X, Wen J et al (2008) Clinical value of minimally invasive percutaneous nephrolithotomy in the supine position under the guidance of real-time ultrasound: report of 92 cases. Urol Res 36:111–114PubMedCrossRefGoogle Scholar
  10. 10.
    Rana AM, Bhojwani JP, Junejo NN et al (2008) Tubeless PCNL with patient in supine position: procedure for all seasons?—with comprehensive technique. Urology 71:581–585PubMedCrossRefGoogle Scholar
  11. 11.
    Scoffone CM, Cracco CM, Cossu M et al (2008) Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: a new standard for percutaneous nephrolithotomy? Eur Urol 54:1393–1403PubMedCrossRefGoogle Scholar
  12. 12.
    Manohar T, Jain P, Desai M (2007) Supine percutaneous nephrolithotomy: effective approach to high-risk and morbidly obese patients. J Endourol 21:44–49PubMedCrossRefGoogle Scholar
  13. 13.
    Ng MT, Sun WH, Cheng CW et al (2004) Supine position is safe and effective for percutaneous nephrolithotomy. J Endourol 18:469–474PubMedCrossRefGoogle Scholar
  14. 14.
    Neto EA, Mitre AI, Gomes CM et al (2007) Percutaneous nephrolithotripsy with the patient in a modified supine position. J Urol 178:165–168PubMedCrossRefGoogle Scholar
  15. 15.
    Yadav R, Aron M, Gupta NP et al (2006) Safety of supracostal punctures for percutaneous renal surgery. Int J Urol 13:1267–1270PubMedCrossRefGoogle Scholar
  16. 16.
    Aron M, Yadav R, Goel R et al (2005) Multi-tract percutaneous nephrolithotomy for large complete staghorn calculi. Urol Int 75:327–332PubMedCrossRefGoogle Scholar
  17. 17.
    Koo BC, Burtt G, Burgess NA (2004) Percutaneous stone surgery in the obese: outcome stratified according to body mass index. BJU Int 93:1296–1299PubMedCrossRefGoogle Scholar
  18. 18.
    Basiri A, Mehrabi S, Kianian H et al (2007) Blind puncture in comparison with fluoroscopic guidance in percutaneous nephrolithotomy: a randomized controlled trial. Urol J 4:79–83PubMedGoogle Scholar
  19. 19.
    Basiri A, Ziaee AM, Kianian HR et al (2008) Ultrasonographic versus fluoroscopic access for percutaneous nephrolithotomy: a randomized clinical trial. J Endourol 22:281–284PubMedCrossRefGoogle Scholar
  20. 20.
    Osman M, Wendt-Nordahl G, Heger K et al (2005) Percutaneous nephrolithotomy with ultrasonography-guided renal access: experience from over 300 cases. BJU Int 96:875–878PubMedCrossRefGoogle Scholar
  21. 21.
    Holman E, Salah MA, Tóth C (2002) Comparison of 150 simultaneous bilateral and 300 unilateral percutaneous nephrolithotomies. J Endourol 16:33–36PubMedCrossRefGoogle Scholar
  22. 22.
    Yadav R, Gupta NP, Gamanagatti S (2008) Supra-twelfth supracostal access: when and where to puncture? J Endourol 22:1209–1212PubMedCrossRefGoogle Scholar
  23. 23.
    Sofikerim M, Demirci D, Huri E et al (2007) Tubeless percutaneous nephrolithotomy: safe even in supracostal access. J Endourol 21:967–972PubMedCrossRefGoogle Scholar
  24. 24.
    Wong MY (1998) Evolving technique of percutaneous nephrolithotomy in a developing country: Singapore General Hospital experience. J Endourol 12:397–401PubMedCrossRefGoogle Scholar
  25. 25.
    Tefekli A, Ali Karadag M, Tepeler K et al (2008) Classification of percutaneous nephrolithotomy complications using the modified clavien grading system: looking for a standard. Eur Urol 53:184–190PubMedCrossRefGoogle Scholar
  26. 26.
    Ziaee SA, Karami H, Aminsharifi A (2007) One-stage tract dilation for percutaneous nephrolithotomy: is it justified? J Endourol 21:1415–1420PubMedCrossRefGoogle Scholar
  27. 27.
    Portis AJ, Laliberte MA, Holtz C et al (2008) Confident intraoperative decision making during percutaneous nephrolithotomy: does this patient need a second look? Urology 71:218–222PubMedCrossRefGoogle Scholar
  28. 28.
    Raza A, Moussa S, Smith G et al (2008) Upper-pole puncture in percutaneous nephrolithotomy: a retrospective review of treatment safety and efficacy. BJU Int 101:599–602PubMedCrossRefGoogle Scholar
  29. 29.
    Meinbach DS, Modling D (2008) Percutaneous management of large renal stones in a private practice community setting. J Endourol 22:447–451PubMedCrossRefGoogle Scholar
  30. 30.
    Margel D, Lifshitz DA, Kugel V et al (2005) Percutaneous nephrolithotomy in patients who previously underwent open nephrolithotomy. J Endourol 19:1161–1164PubMedCrossRefGoogle Scholar
  31. 31.
    El-Assmy AM, Shokeir AA, El-Nahas AR et al (2007) Outcome of percutaneous nephrolithotomy: effect of body mass index. Eur Urol 52:199–204PubMedCrossRefGoogle Scholar
  32. 32.
    Pearle MS, Nakada SY, Womack JS et al (1998) Outcomes of contemporary percutaneous nephrostolithotomy in morbidly obese patients. J Urol 160:669–673PubMedCrossRefGoogle Scholar
  33. 33.
    Sergeyev I, Koi PT, Jacobs SL et al (2007) Outcome of percutaneous surgery stratified according to body mass index and kidney stone size. Surg Laparosc Endosc Percutan Tech 17:179–183PubMedCrossRefGoogle Scholar
  34. 34.
    Clayman RV (2005) Percutaneous nephrolithotomy: an update. J Urol 173:1199Google Scholar
  35. 35.
    Autorino R, Giannarini G (2008) Prone or supine: is this the question? Eur Urol 54:1216–1218PubMedCrossRefGoogle Scholar
  36. 36.
    Ibarluzea G, Scoffone CM, Cracco CM et al (2007) Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access. BJU Int 100:233–236PubMedCrossRefGoogle Scholar
  37. 37.
    de la Rosette JJ, Tsakiris P, Ferrandino MN et al (2008) Beyond prone position in percutaneous nephrolithotomy: a comprehensive review. Eur Urol 54:1262–1269CrossRefGoogle Scholar
  38. 38.
    Vicentini FC, Gomes CM, Danilovic A et al (2009) Percutaneous nephrolithotomy: current concepts. Indian J Urol 25:4–10PubMedCrossRefGoogle Scholar
  39. 39.
    LeRoy AJ, Williams HJ Jr, Bender CE et al (1985) Colon perforation following percutaneous nephrostomy and renal calculus removal. Radiology 155:83–85PubMedGoogle Scholar
  40. 40.
    Preminger GM, Schultz S, Clayman RV et al (1987) Cephalad renal movement during percutaneous nephrostolithotomy. J Urol 137:623–625PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2010

Authors and Affiliations

  1. 1.Department of Urology, West China HospitalSichuan UniversityChengduChina
  2. 2.Chinese Evidence-based Medicine Centre, West China HospitalSichuan UniversityChengduChina

Personalised recommendations