title: Percutaneous nephrolithotomy in the oblique supine lithotomy position and prone position: a comparative study.
abstract: OBJECTIVE
  To compare the safety, efficacy, and complications of percutaneous nephrolithotomy (PCNL) in the oblique supine lithotomy position vs the prone position in a randomized comparative study.
  
  
  METHODS
  The study included 101 and 102 patients in the oblique supine lithotomy position and prone position, respectively. Inclusion criteria were renal and upper ureteral stones. Exclusion criteria were uncorrectable bleeding disorders, active urinary tract infection, and pregnancy.
  
  
  RESULTS
  Both the groups were comparable regarding the male/female ratio, stone size, and site. No significant differences were found in terms of the stone-free rate, blood transfusion rate, and complication rates. Significant differences were reported in mean hemoglobin loss (-1.03 and -2.18 g/dL), mean operative time (86.16 and 111.7 minutes), and mean hospital stay (49.88 and 81.2 hours) in the supine and prone positions, respectively, and anesthesiological parameters (the mean blood pressure decreased by 2 and 14.06 mm Hg, the mean heart rate changed by -0.82 and +13.28 beat/minute, and the peak air way pressure changed by +1.08 cm H2O and +7.56 cm H2O in the supine and prone positions, respectively).
  
  
  CONCLUSIONS
  PCNL in both positions was equally successful with no significant differences in complications. PCNL in the oblique supine lithotomy position was superior to PCNL in the prone position regarding operative time, hospital stay, and effects on respiratory and cardiovascular status, making it more comfortable for patients and anesthesiologists. Morbidly obese patients, patients with cardiologic disorders, and patients with pulmonary obstructive airway disease need further studies to show if they would benefit from these differences. Additionally, it is more comfortable for the surgeon with little challenges added in the initial puncture.
authors.affiliation: 1 Department of Urology, Faculty of Medicine, Beni Suef University , Beni Suef, Egypt .
authors.forename: Ahmad Aref
authors.initials: AA
authors.lastname: Al-Dessoukey
authors.forename: Ayman Salah
authors.initials: AS
authors.lastname: Moussa
authors.forename: Ahmed Mahmoud
authors.initials: AM
authors.lastname: Abdelbary
authors.forename: Ahmed
authors.initials: A
authors.lastname: Zayed
authors.forename: Rabie
authors.initials: R
authors.lastname: Abdallah
authors.forename: Ahmad A
authors.initials: AA
authors.lastname: Elderwy
authors.forename: Amr Medhat
authors.initials: AM
authors.lastname: Massoud
authors.forename: Aly Hussein
authors.initials: AH
authors.lastname: Aly
mesh_terms: D000328:Adult; D000768:Anesthesia, General; D001794:Blood Pressure / Q000502:physiology; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007668:Kidney / Q000601:surgery; D007669:Kidney Calculi / Q000097:blood / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000379:methods*; D009767:Obesity, Morbid / Q000601:surgery; D061646:Operative Time; D056888:Patient Positioning / Q000379:methods*; D016684:Prone Position; D011446:Prospective Studies; D016683:Supine Position; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000097:blood / Q000601:surgery*