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Comparison between prone and supine nephrolithotomy in pediatric population: a double center experience

  • Urology - Original Paper
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Abstract

Purpose

Stone disease in the pediatric age is an increasing issue. Percutaneous Nephrolithotomy (PNL) can be used for larger and complex stones. As in adults it can be performed in the supine or prone position.

Methods

We retrospectively reviewed two centers’ experience in prone and supine PNL in children to analyze its results and complications.

Results

33 patients underwent prone and 19 supine procedures. Patients in the prone group were younger than in the supine, while no significant differences were found in stone burden, access size, operative time or complications. Complications were: 8 and 4 Clavien 1 for the prone and supine group, respectively, one case of urosepsis (4b) in the prone and 2 cases of Clavien 3 in the supine group (double J stent placement for renal colic and ureteroscopy for steinstrasse). Tubeless procedures and mean nephrostomy time were in favor of the supine group, whereas fluoroscopy time and ureteral drainage stay were in support of the prone group. Stone free rate was better in the supine group (83.3 vs 66.6%), possibly reflecting the capability to perform a combined approach in 12 patients (allowing to reach all the calyx with simultaneous anterograde and retrograde access) or younger age in the prone group (13 vs 2 patients ≤5 years), with no differences in stone burden.

Conclusions

Supine approach seems to guarantee higher stone-free rates. Larger series are necessary to determine what the best technique is in terms of X-ray exposure, operative time and complications.

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Authors and Affiliations

  1. Department of Urology, University Hospital of Parma/Azienda Ospedaliero, Universitaria Di Parma, Via Gramsci 14, 43126, Parma, Italy

    Davide Campobasso, Tommaso Bocchialini, Giulio Guarino, Pietro Granelli, Paolo Salsi, Umberto Maestroni & Stefania Ferretti

  2. Department of Urology, University of Modena and Reggio Emilia, Modena, Italy

    Luigi Bevilacqua, Giulio Guarino, Corradino Di Pietro, Pietro Oltolina, Stefano Puliatti, Giampaolo Bianchi & Salvatore Micali

  3. SS Endourology and Less Invasive Percutaneous Surgery, University Hospital of Parma, Urology OU, Parma, Italy

    Pietro Granelli, Paolo Salsi & Stefania Ferretti

  4. Department of Engineering and Architecture, University of Parma, Parma, Italy

    Davide Mezzogori

  5. Paediatric Surgery Unit, University Hospital of Parma, Parma, Italy

    Claudia Gatti

  6. Pediatric Surgical Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy

    Pier Luca Ceccarelli

  7. Urology Unit, Civil Hospital of Guastalla, Azienda USL—IRCCS di Reggio Emilia, Guastalla, Italy

    Antonio Frattini

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  1. Davide Campobasso
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All authors have contributed to the paper.

Corresponding author

Correspondence to Davide Campobasso.

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The authors certify that there are no conflicts of interest with any financial organization regarding the material discussed in the manuscript.

We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome and the paper is not previous presented or publicated.

This analysis was performed according to the principles outlined in the Declaration of Helsinki.

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Campobasso, D., Bocchialini, T., Bevilacqua, L. et al. Comparison between prone and supine nephrolithotomy in pediatric population: a double center experience. Int Urol Nephrol 54, 3063–3068 (2022). https://doi.org/10.1007/s11255-022-03341-y

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