title: How well tolerated is supine percutaneous nephrolithotomy?
abstract: OBJECTIVE
  Supine percutaneous nephrolithotomy (PCNL) has been described in 1988 and several modifications followed since. Despite claimed benefits, supine PCNL is still neglected by the majority of urologists. Lack of experience and the fear of complications are possible explanations for the resistance to supine positioning. This review evaluates recent literature on the use of supine PCNL, focussing on benefits and safety.
  
  
  RESULTS
  The Clinical Research Office of the Endourological Society Global Study and several (retrospective) reports comment on efficacy and safety of PCNL, differences in techniques, or identify conditions and patient factors for best practice. Anesthesiologic benefits (especially in the high risk, cardiopulmonary compromised, patient) and anatomical advantages are described in supine position theoretically favoring safety of supine PCNL. However, there are no prospective randomized studies conducted to support this assumption. Overall, benefits in efficacy or safety, of one position over the other, are not yet proven.
  
  
  CONCLUSIONS
  Supine PCNL has advantages in selected patients. Ultimately, the decision on position should be made on patient's characteristics and surgeon's preference and experience.
authors.affiliation: Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Joyce
authors.initials: J
authors.lastname: Baard
authors.forename: Guido M
authors.initials: GM
authors.lastname: Kamphuis
authors.forename: Matias
authors.initials: M
authors.lastname: Westendarp
authors.forename: Jean J M C H
authors.initials: JJ
authors.lastname: de la Rosette
mesh_terms: D006801:Humans; D007669:Kidney Calculi / Q000175:diagnosis / Q000601:surgery*; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects; D056888:Patient Positioning; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D016683:Supine Position; D016896:Treatment Outcome