• Ahmad Aref Al-Dessoukey, Ayman Salah Moussa, Ahmed Mahmoud Abdelbary, Ahmed Zayed, Rabie Abdallah, Ahmad A Elderwy, Amr Medhat Massoud, and Aly Hussein Aly.
• 1 Department of Urology, Faculty of Medicine, Beni Suef University , Beni Suef, Egypt .
• J. Endourol. 2014 Sep 1;28(9):1058-63.

ObjectivesTo 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.Patients And MethodsThe 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.ResultsBoth 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).ConclusionsPCNL 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.

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