title: Prone Versus Supine Percutaneous Nephrolithotomy: What Is Your Position?
abstract: OBJECTIVE
  Percutaneous nephrolithotomy (PCNL) is the gold standard surgical procedure for treating large, complex renal stones. Due to its challenging nature, PCNL has undergone many modifications in surgical technique, instruments, and also in patient positioning. Since the first inception of PCNL, prone position has been traditionally used. However, alternative positions have been proposed and assessed over the years. This is a comprehensive review on the latest developments related to positioning in the practice of PCNL.
  
  
  RESULTS
  The prone position and its modifications are the most widely used positions for PCNL, but with the introduction of various supine positions, the optimal position has been up for debate. Recent meta-analysis has shown a superior stone-free rate in the prone position and comparable complication rates to the supine position. The advantage of ease of access to the urethra for simultaneous retrograde techniques in the supine position is also possible with modifications in the prone position such as the split-leg technique. Modern-day PCNL has transformed from an operation traditionally undertaken in the prone position to a procedure in which a prone or supine position may be employed; however, published data have not shown significant superiority of either approach.
authors.affiliation: Department of Urology, University of California, Irvine, 333 City Boulevard West, Suite 2100, Orange, CA, 92868, USA. roshanmp@uci.edu.
authors.forename: Roshan M
authors.initials: RM
authors.lastname: Patel
authors.affiliation: Department of Urology, University of California, Irvine, 333 City Boulevard West, Suite 2100, Orange, CA, 92868, USA.
authors.forename: Zhamshid
authors.initials: Z
authors.lastname: Okhunov
authors.affiliation: Department of Urology, University of California, Irvine, 333 City Boulevard West, Suite 2100, Orange, CA, 92868, USA.
authors.forename: Ralph V
authors.initials: RV
authors.lastname: Clayman
authors.affiliation: Department of Urology, University of California, Irvine, 333 City Boulevard West, Suite 2100, Orange, CA, 92868, USA.
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
mesh_terms: D006801:Humans; D007669:Kidney Calculi / Q000601:surgery; D009403:Nephrostomy, Percutaneous / Q000379:methods; D056888:Patient Positioning / Q000379:methods; D016684:Prone Position; D016683:Supine Position; D016896:Treatment Outcome
keywords: Kidney stones; Percutaneous nephrolithotomy; Positioning; Prone; Supine; Urolithiasis