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Could pain change position choice? Comparison of pain level, analgesic requirement and hospitalization time in supine and prone percutaneous nephrolithotomy

  • Urology - Original Paper
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A Correction to this article was published on 26 December 2023

This article has been updated

Abstract

Purpose

Investigation of how position affects postoperative pain levels and hospitalization in patients undergoing percutaneous nephrolithotomy (PNL) surgery.

Methods

Between August 2019 and December 2022, a total of 156 patients who underwent prone (pPNL) and supine percutaneous nephrolithotomy (sPNL) due to kidney stones were included in the study. Demographic data, preoperative CT scans, laboratory results, transfusion rates, operation durations, complication rates, stone-free rates, analgesic use, nephrostomy removal time, hospitalization duration, fluoroscopy time, hemoglobin decrease and postoperative Visual Analog Scale (VAS) scores were evaluated for all patients. By comparing these data between the sPNL and pPNL groups, the effect of position selection in PNL on pain control, analgesic requirement, and hospitalization duration was examined.

Results

In the comparison of the pPNL and sPNL groups, there was a significant difference between the two groups in body mass index, hounsfield unit, complication rate, analgesic rate, nephrostomy remove time, hospitalization time, operation time, fluoroscopy time and VAS score (p = 0.025, p < 0.001, p = 0.012, p = 0.012, p < 0.001, p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively).

Conclusion

The shorter operation and hospitalization time in the sPNL group could be attributed to performing surgeries in a physiological position. Additionally, sPNL seems advantageous in terms of patients' pain levels, hospitalization time and VAS scores. One reason for this could be the different areas of access in sPNL and pPNL, which may correspond to different dermatome regions. Considering the low level of pain and reduced analgesic usage, sPNL appears to be advantageous.

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Data availability

Our data is available upon request.

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References

  1. Shafi H, Moazzami B, Pourghasem M, Kasaeian A (2016) An overview of treatment options for urinary stones. Caspian J Intern Med 7(1):1–6

    PubMed  PubMed Central  Google Scholar 

  2. Manohar T, Jain P, Desai M (2007) Supine percutaneous nephrolithotomy: effective approach to high-risk and morbidly obese patients. J Endourol 21(1):44–49

    Article  CAS  PubMed  Google Scholar 

  3. Ibarluzea G, Scoffone CM, Cracco CM, Poggio M, Porpiglia F, Terrone C, Astobieta A, Camargo I, Gamarra M, Tempia A (2007) Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access. BJU Int 100(1):233–236

    Article  PubMed  Google Scholar 

  4. Miano R, Scoffone C, De Nunzio C, Germani S, Cracco C, Usai P, Tubaro A, Kim FJ, Micali S (2010) Position: prone or supine is the issue of percutaneous nephrolithotomy. J Endourol 24(6):931–938

    Article  PubMed  Google Scholar 

  5. Zhao F, Li J, Tang L, Li C (2021) A comparative study of endoscopic combined intrarenal surgery (ECIRS) in the galdakao-modified supine valdivia (GMSV) position and minimally invasive percutaneous nephrolithotomy for complex nephrolithiasis: a retrospective single-center study. Urolithiasis 49:161–166

    Article  PubMed  Google Scholar 

  6. Proietti S, Rodríguez-Socarrás ME, Eisner B, De Coninck V, Sofer M, Saitta G, Rodriguez-Monsalve M, D’Orta C, Bellinzoni P, Gaboardi F (2019) Supine percutaneous nephrolithotomy: tips and tricks. Transl Androl Urol 8(Suppl 4):S381

    Article  PubMed  PubMed Central  Google Scholar 

  7. Gülpinar B, Akinci A, Süer E, Sanci A, Babayiğit M, Bedük Y, Baltaci S, Gökce Mİ (2018) Prospective evaluation of kidney displacement during supine mini-percutaneous nephrolithotomy: incidence, significance, and analysis of predictive factors. Can Urol Assoc J 12(11):E475

    Article  PubMed  PubMed Central  Google Scholar 

  8. Mak DK-C, Smith Y, Buchholz N, El-Husseiny T (2016) What is better in percutaneous nephrolithotomy–prone or supine? A systematic review. Arab J Urol 14(2):101–107

    Article  PubMed  PubMed Central  Google Scholar 

  9. Carr DB (1999) Goudas. LC Acute pain lancet 353(9169):2051–2058

    CAS  Google Scholar 

  10. Breivik H (1998) Postoperative pain management: why is it difficult to show that it improves outcome. Eur J Anaesthesiol EJA 15(6):748–751

    Article  CAS  Google Scholar 

  11. Edgcombe H, Carter K, Yarrow S (2008) Anaesthesia in the prone position. Br J Anaesth 100(2):165–183

    Article  CAS  PubMed  Google Scholar 

  12. Huskisson EC (1974) Measurement of pain. The Lancet 304(7889):1127–1131

    Article  Google Scholar 

  13. VASSS ODIO, (2011) Validation of the Turkish version of the visual analog scale spine score in patients with spinal fractures. Acta Orthop Traumatol Turc 45(5):353–358

    Google Scholar 

  14. Faul F, Erdfelder E, Lang A-G, Buchner A (2007) G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39(2):175–191. https://doi.org/10.3758/BF03193146

    Article  PubMed  Google Scholar 

  15. Lehman T, Bagley DH (1988) Reverse lithotomy: modified prone position for simultaneous nephroscopic and ureteroscopic procedures in women. Urology 32(6):529–531

    Article  CAS  PubMed  Google Scholar 

  16. Borin JF (2008) Prone retrograde laser lithotripsy facilitates endoscope-guided percutaneous renal access for staghorn calculi: two scopes are better than one. J Endourol 22(9):1881–1884

    Article  PubMed  Google Scholar 

  17. Khan F, Borin JF, Pearle MS, McDougall EM, Clayman RV (2006) Endoscopically guided percutaneous renal access: seeing is believing. J Endourol 20(7):451–455

    Article  PubMed  Google Scholar 

  18. Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, Keefe FJ, Mogil JS, Ringkamp M, Sluka KA, Song XJ, Stevens B, Sullivan MD, Tutelman PR, Ushida T, Vader K (2020) The revised international association for the study of pain definition of pain: concepts, challenges, and compromises. Pain 161(9):1976–1982. https://doi.org/10.1097/j.pain.0000000000001939

    Article  PubMed  PubMed Central  Google Scholar 

  19. Stecco C, Pirri C, Fede C, Fan C, Giordani F, Stecco L, Foti C, De Caro R (2019) Dermatome and fasciatome. Clin Anat 32(7):896–902. https://doi.org/10.1002/ca.23408

    Article  PubMed  Google Scholar 

  20. Paris SV (1983) Anatomy as related to function and pain. Orthop Clin North Am 14(3):475–489

    Article  CAS  PubMed  Google Scholar 

  21. Lee M, McPhee R, Stringer M (2008) An evidence-based approach to human dermatomes. Clin Anat Off J Am Assoc Clin Anat Br Assoc Clin Anat 21(5):363–373

    CAS  Google Scholar 

  22. Murphy DR, Hurwitz EL, Gerrard JK, Clary R (2009) Pain patterns and descriptions in patients with radicular pain: does the pain necessarily follow a specific dermatome? Chiropr Osteopat 17:1–9

    Article  Google Scholar 

  23. Al-Dessoukey AA, Moussa AS, Abdelbary AM, Zayed A, Abdallah R, Elderwy AA, Massoud AM, Aly AH (2014) Percutaneous nephrolithotomy in the oblique supine lithotomy position and prone position: a comparative study. J Endourol 28(9):1058–1063

    Article  PubMed  Google Scholar 

  24. Jamil MN, Shaheen R, Farooq U (2022) Comparison between supine position versus prone position in percutaneous nephrolithotomy: a single centered analysis Of 623 cases. J Ayub Med Coll Abbottabad-Pak. https://doi.org/10.55519/JAMC-04-S4-11259

    Article  Google Scholar 

  25. Roodneshin F, Kermany MPZN, Rostami P, Ahmadzadeh N, Gharaei B, Kamranmanesh MR (2020) Comparison of hemodynamic stability and pain control in lateral and prone positions in patients undergoing percutaneous nephrolithotomy: a randomized controlled trial. Urol J 17(2):124

    PubMed  Google Scholar 

  26. Liu L, Zheng S, Xu Y, Wei Q (2010) Systematic review and meta-analysis of percutaneous nephrolithotomy for patients in the supine versus prone position. J Endourol 24(12):1941–1946

    Article  PubMed  Google Scholar 

  27. Wu P, Wang L, Wang K (2011) Supine versus prone position in percutaneous nephrolithotomy for kidney calculi: a meta-analysis. Int Urol Nephrol 43:67–77

    Article  PubMed  Google Scholar 

  28. Birowo P, Tendi W, Widyahening IS, Rasyid N, Atmoko W (2020) Supine versus prone position in percutaneous nephrolithotomy: a systematic review and meta-analysis. F1000Research 9(231):231

    Article  PubMed  PubMed Central  Google Scholar 

  29. De Sio M, Autorino R, Quarto G, Calabro F, Damiano R, Giugliano F, Mordente S, D’Armiento M (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(1):196–203

    Article  PubMed  Google Scholar 

  30. 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(3):388–392

    Article  PubMed  Google Scholar 

  31. Ding YY, Yao P, Wu L, Han ZK, Hong T, Zhu YQ, Li HX (2017) Body mass index and persistent pain after breast cancer surgery: findings from the women’s healthy eating and living study and a meta-analysis. Oncotarget 8(26):43332–43343. https://doi.org/10.18632/oncotarget.17948

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We would like to thank engineer Mehmet Miraç Şimsek, who drew the Fig. 1 and Fig. 2 in our study, for his contributions to this manuscript.

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Authors and Affiliations

  1. Department of Urology, School of Medicine, Gazi University, Gazi Hastanesi Sağlık, Araştırma Ve Uygulama Merkezi, 12. Kat Üroloji Polikliniği, Ankara, Turkey

    Ender Cem Bulut, Çağrı Coşkun, Murat Yavuz Koparal & Nihat Karabacak

  2. Department of Urology, Ağrı Research and Training Hospital, Ağrı, Turkey

    Uğur Aydın

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  1. Ender Cem Bulut
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  2. Çağrı Coşkun
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  3. Murat Yavuz Koparal
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Correspondence to Çağrı Coşkun.

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The study was approved by the medical ethics committee of Gazi University Faculty of Medicine on 23 March 2022 (approval number: 83).

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Bulut, E.C., Coşkun, Ç., Koparal, M.Y. et al. Could pain change position choice? Comparison of pain level, analgesic requirement and hospitalization time in supine and prone percutaneous nephrolithotomy. Int Urol Nephrol 56, 1273–1280 (2024). https://doi.org/10.1007/s11255-023-03873-x

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