Prone Versus Supine PNL: Results and Published Series

  • András HoznekEmail author
  • Julie Rode
  • Cecilia Maria Cracco
  • Cesare Marco Scoffone


There is still much controversy in the literature concerning the optimal approach for PNL. Although prone PNL remains predominant on a global level, with a superior acquired experience and more training opportunities when compared to supine position, supine PNL is increasingly used and it is now quite consensual that it allows an easier management from the anaesthesiological point of view and may reduce patient morbidity. The available randomized studies demonstrate that in centers which already standardized the supine technique, this procedure may be more ergonomic and quicker and equally efficient in terms of stone clearance and morbidity.


Supine Position Prone Position Stone Clearance Residual Fragment Multiple Puncture 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Valdivia Uría 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
  2. 2.
    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
  3. 3.
    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
  4. 4.
    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
  5. 5.
    Ng MT, Sun WH, Cheng CW, Chan ES (2004) Supine position is safe and effective for percutaneous nephrolithotomy. J Endourol 18:469–474PubMedCrossRefGoogle Scholar
  6. 6.
    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(6):1393–1403PubMedCrossRefGoogle Scholar
  7. 7.
    Shoma AM, Eraky I, El-Kenawy MR, El-Kappany HA (2002) Percutaneous nephrolithotomy in the supine position: technical aspects and functional outcome compared with the prone technique. Urology 60:388–392PubMedCrossRefGoogle 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.
    de la Rosette JJ, Tsakiris P, Ferrandino MN et al (2008) Beyond prone position in percutaneous nephrolithotomy: a comprehensive review. Eur Urol 54:1262–1269PubMedCrossRefGoogle Scholar
  10. 10.
    Basiri A, Mohammadi Sichani M (2009) Supine percutaneous nephrolithotomy, is it really effective? A systematic review of literature. Urol J 6:73–77PubMedGoogle Scholar
  11. 11.
    Thomas K, Smith NC, Hegarty N, Glass JM (2011) The Guy’s stone score – grading the complexity of percutaneous nephrolithotomy procedures. Urology 78:277–281PubMedCrossRefGoogle Scholar
  12. 12.
    Hyams ES, Bruhn A, Lipkin M, Shah O (2010) Heterogeneity in the reporting of disease characteristics and treatment outcomes in studies evaluating treatments for nephrolithiasis. J Endourol 24:1411–1414PubMedCrossRefGoogle Scholar
  13. 13.
    Deters LA, Jumper CM, Steinberg PL, Pais VM (2011) Evaluating the definition of “stone free status” in contemporary urologic literature. Clin Nephrol 76:354–357PubMedCrossRefGoogle Scholar
  14. 14.
    Denstedt JD, Clayman RV, Picus DD (1991) Comparison of endoscopic and radiological residual fragment rate following percutaneous nephrolithotripsy. J Urol 145:703–705PubMedGoogle Scholar
  15. 15.
    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
  16. 16.
    de la Rosette JJ, Opondo D, Daels FP et al (2012) Categorisation of complications and validation of the Clavien score for percutaneous nephrolithotomy. Eur Urol 62:246–255PubMedCrossRefGoogle Scholar
  17. 17.
    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
  18. 18.
    Zhou X, Gao X, Wen J, Xiao C (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
  19. 19.
    Rana AM, Bhojwani JP, Junejo NN, Das Bhagia S (2008) Tubeless PCNL with patient in supine position: procedure for all seasons? – with comprehensive technique. Urology 71:581–585PubMedCrossRefGoogle Scholar
  20. 20.
    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
  21. 21.
    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
  22. 22.
    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
  23. 23.
    Pearle MS, Nakada SY, Womack JS, Kryger JV (1998) Outcomes of contemporary percutaneous nephrostolithotomy in morbidly obese patients. J Urol 160:669–673PubMedCrossRefGoogle Scholar
  24. 24.
    Mazzucchi E, Vicenitni FC, Marchini GS et al (2012) Percutaneous nephrolithotomy in obese patients: comparison between the prone and total supine position. J Endourol 26:1437–1442PubMedCrossRefGoogle Scholar
  25. 25.
    Valdivia JG, Scarpa RM, Duvdevani M et al (2011) Supine versus prone position during percutaneous nephrolithotomy: a report from the clinical research office of the endourological society percutaneous nephrolithotomy global study. J Endourol 25:1619–1625PubMedCrossRefGoogle Scholar
  26. 26.
    Yamaguchi A, Skolarikos A, Buchholz NP et al (2011) Operating times and bleeding complications in percutaneous nephrolithotomy: a comparison of tract dilation methods in 5,537 patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study. J Endourol 25:933–939PubMedCrossRefGoogle Scholar
  27. 27.
    Falahatkar S, Maghaddam AA, Salehi M et al (2008) Complete supine percutaneous nephrolithotripsy comparison with the prone standard technique. J Endourol 22:2513–2517PubMedCrossRefGoogle Scholar

Further Reading

  1. Kumar P, Bach C, Kachrilas S et al (2012) Supine percutaneous nephrolithotomy (PCNL): “in vogue” but in which position? BJU Int 110:E1018–E1021PubMedCrossRefGoogle Scholar
  2. Duty B, Okhunov Z, Smith A, Okeke Z (2011) The debate over percutaneous nephrolithotomy positioning: a comprehensive review. J Urol 186:20–25PubMedCrossRefGoogle Scholar
  3. Lardon R, Lacroix B, Lorin S, Mottet N (2012) Prone and supine position for percutaneous nephrolithotomy: is it necessary to change the operative technique? Prog Urol 22:154–158PubMedCrossRefGoogle Scholar
  4. Wu P, Wang L, Wang K (2011) Supine versus prone position in percutaneous nephrolithotomy for kidney calculi: a meta-analysis. Int Urol Nephrol 43:67–77PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2014

Authors and Affiliations

  • András Hoznek
    • 1
    Email author
  • Julie Rode
    • 1
  • Cecilia Maria Cracco
    • 2
  • Cesare Marco Scoffone
    • 2
  1. 1.Department of UrologyCHU Henri MondorCréteil CedexFrance
  2. 2.Department of UrologyCottolengo HospitalTorinoItaly

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