Abstract

Percutaneous nephrolithotomy (PCNL) is the preferred treatment for large and complex renal calculi. Traditionally, the prone position has been widely used due to its direct access to the renal collecting system. However, the supine position has gained popularity due to its advantages in anesthesia, surgical ergonomics, and patient safety. This review compares supine and prone PCNL in terms of stone-free rates (SFR), operative time, blood loss, complications, and perioperative outcomes. A review of the literature was conducted, analyzing studies that compared supine and prone PCNL. Key parameters included SFR, operative time, blood loss, transfusion rates, complications, and patient recovery. Randomized controlled trials, meta-analyses, and large cohort studies were reviewed to determine comparative effectiveness and safety. Both supine and prone PCNL achieve comparable SFR, with no statistically significant differences in final clearance rates. Supine PCNL demonstrates shorter operative times, averaging 12-21 minutes less than prone PCNL. Blood loss and trans fusion rates are generally similar, although some studies suggest a slight advantage for supine positioning in reducing transfusion needs. Complication rates are comparable, but supine PCNL is associated with a lower incidence of postoperative fever and sepsis, possibly due to improved drainage and lower intrarenal pressure. While prone PCNL offers a more familiar anatomical orientation for urologists and better access to upper-pole stones, supine PCNL facilitates simultaneous retrograde intrarenal surgery (ECIRS) and reduces anesthetic complications, making it advantageous for high-risk patients. Both prone and supine PCNL are effective and safe for treating large renal stones. The choice of position should be tailored to patient-specific factors, stone characteristics, and surgeon experience. Supine PCNL may be preferable for patients with anesthetic risks or when ECIRS is planned, while prone PCNL remains advantageous for complex upper-pole stones requiring multiple punctures. Further randomized studies are needed to establish definitive guidelines for position selection.

Key words: Keywords: percutaneous nephrolithotomy, perioperative outcomes, prone PCNL, stone-free rates, supine PCNL.