title: Supine versus prone position during percutaneous nephrolithotomy: a report from the clinical research office of the endourological society percutaneous nephrolithotomy global study.
abstract: OBJECTIVE
  To determine differences in patients' characteristics, operative time and procedures, and perioperative outcomes between prone and supine positioning in percutaneous nephrolithotomy (PCNL) using the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study database.
  
  
  METHODS
  Between November 2007 and December 2009, prospective data were collected on a total of 5803 consecutive patients who were treated over a 1-year period at each of 96 participating global centers. Patients with data on body position were dichotomized into prone or supine PCNL.
  
  
  RESULTS
  The majority of PCNL treatments were performed in the prone position (n=4637; 80.3% of sample). Differences in patient characteristics included in the prone group: A greater proportion of males (57.4% vs 52.2%); younger age (48.8 y vs 51.0 y); less frequent history of shockwave lithotripsy (19.5% vs 28.6%); greater frequency of American Society of Anesthesiologists score of 1 (54.7% vs 46.8%); and a Clavien grade of 2 or more (10.0% vs 7.2%). The mean operative time was significantly lower for prone vs supine PCNL (82.7 min vs 90.1 min) regardless of the method of tract dilation, while the stone-free rate was significantly higher (77.0% vs 70.2%). Compared with supine patients, prone patients exhibited higher rates of blood transfusions (6.1% vs 4.3%) and fever (11.1% vs 7.6%), but lower rates of failed procedures (1.5% vs 2.7%).
  
  
  CONCLUSIONS
  Since operative time and stone-free rates favor prone PCNL, but patient safety favors supine PCNL, the choice of patient position should be tailored to individual patient characteristics and the surgeon's preference.
authors: Department of Urology, Clinical University Hospital Lozano Blesa , Zaragoza, Spain.
authors: José G
authors: JG
authors: Valdivia
authors: Roberto M
authors: RM
authors: Scarpa
authors: Mordechai
authors: M
authors: Duvdevani
authors: Andreas J
authors: AJ
authors: Gross
authors: Robert B
authors: RB
authors: Nadler
authors: Kikuo
authors: K
authors: Nutahara
authors: Jean J M C H
authors: JJ
authors: de la Rosette
mesh_terms: D035843:Biomedical Research; D005260:Female; D005843:Geography; D006801:Humans; D038622:Internationality; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D019990:Perioperative Care; D016684:Prone Position; D012955:Societies, Medical; D016683:Supine Position; D013997:Time Factors; D016896:Treatment Outcome; D014572:Urology