Patient positioning during percutaneous nephrolithotomy: what is the current best practice?

Figures & data

Table 1 Advantages and disadvantages of each position

	Advantages	Disadvantages
Prone	1. Easy puncture 2. Routine dilatation with short tracts 3. Multiple punctures easier due to large operative field 4. Easier access in morbid obese patients 5. Preferred in horseshoe kidneys	1. No or difficult synchronous RIRS 2. 20–25 minutes more for a safe positioning 3. Challenging position for the anesthetist 4. Require patient repositioning (may increase rates of spine and skeletal injury)
Supine	1. Synchronous RIRS (in some modified positions) 2. Routine position for anesthetist 3. No patient repositioning 4. Lesser time (in some studies) 5. Preferred in pelvic kidneys 6. No requirement for fluoroscopy	1. Longer tracts (after dilatation) 2. Difficult dilatation due to increased mobility of kidneys (Valdivia) 3. Limited operation field 4. Difficult puncture due to torso rotation (Galdakao-modified Valdivia)

Abbreviation: RIRS, retrograde intrarenal surgery.