Comparison of Prone and Supine Positions for Suction Mini Percutaneous Nephrolithotomy (PCNL) for Kidney Stone Disease. Results from a Prospective Multicenter Series from the Endourology Section of the European Association of Urology and the Suction Mini-PCNL Collaborative Study Group
Issued Date
2026-03-01
Resource Type
eISSN
24054569
Scopus ID
2-s2.0-105032444569
Pubmed ID
41168029
Journal Title
European Urology Focus
Volume
12
Issue
2
Start Page
208
End Page
216
Rights Holder(s)
SCOPUS
Bibliographic Citation
European Urology Focus Vol.12 No.2 (2026) , 208-216
Suggested Citation
Castellani D., Gauhar V., Kalathia J., Mehta A., Gadzhiev N., Malkhasyan V., Kumar N., Kalbit R.H., Gorgotsky I., Gokce M.I., Laymon M., Inoue T., Tak G.R., Baker A., Dholaria P., Chawla A., Beltrán-Suárez E., Mahajan A., Fong K.Y., Yuen S.K.K., Tan K., Omar M., Petkova K., Taguchi K., Ketsuwan C., Lakmichi M.A., Palaniappan S., Tanidir Y., Akdogan N., Cepeda M., Martov A., Tokhtiyev Z., Tzelves L., Skolarikos A., Acuña E., Zawadzki M., Kamal W., Lopes L.G., Gorelov D., Agrawal M.S., Mohan V.C., Herrmann T.R.W., Somani B.K. Comparison of Prone and Supine Positions for Suction Mini Percutaneous Nephrolithotomy (PCNL) for Kidney Stone Disease. Results from a Prospective Multicenter Series from the Endourology Section of the European Association of Urology and the Suction Mini-PCNL Collaborative Study Group. European Urology Focus Vol.12 No.2 (2026) , 208-216. 216. doi:10.1016/j.euf.2025.10.003 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/115723
Title
Comparison of Prone and Supine Positions for Suction Mini Percutaneous Nephrolithotomy (PCNL) for Kidney Stone Disease. Results from a Prospective Multicenter Series from the Endourology Section of the European Association of Urology and the Suction Mini-PCNL Collaborative Study Group
Author(s)
Castellani D.
Gauhar V.
Kalathia J.
Mehta A.
Gadzhiev N.
Malkhasyan V.
Kumar N.
Kalbit R.H.
Gorgotsky I.
Gokce M.I.
Laymon M.
Inoue T.
Tak G.R.
Baker A.
Dholaria P.
Chawla A.
Beltrán-Suárez E.
Mahajan A.
Fong K.Y.
Yuen S.K.K.
Tan K.
Omar M.
Petkova K.
Taguchi K.
Ketsuwan C.
Lakmichi M.A.
Palaniappan S.
Tanidir Y.
Akdogan N.
Cepeda M.
Martov A.
Tokhtiyev Z.
Tzelves L.
Skolarikos A.
Acuña E.
Zawadzki M.
Kamal W.
Lopes L.G.
Gorelov D.
Agrawal M.S.
Mohan V.C.
Herrmann T.R.W.
Somani B.K.
Gauhar V.
Kalathia J.
Mehta A.
Gadzhiev N.
Malkhasyan V.
Kumar N.
Kalbit R.H.
Gorgotsky I.
Gokce M.I.
Laymon M.
Inoue T.
Tak G.R.
Baker A.
Dholaria P.
Chawla A.
Beltrán-Suárez E.
Mahajan A.
Fong K.Y.
Yuen S.K.K.
Tan K.
Omar M.
Petkova K.
Taguchi K.
Ketsuwan C.
Lakmichi M.A.
Palaniappan S.
Tanidir Y.
Akdogan N.
Cepeda M.
Martov A.
Tokhtiyev Z.
Tzelves L.
Skolarikos A.
Acuña E.
Zawadzki M.
Kamal W.
Lopes L.G.
Gorelov D.
Agrawal M.S.
Mohan V.C.
Herrmann T.R.W.
Somani B.K.
Author's Affiliation
Chinese University of Hong Kong
National and Kapodistrian University of Athens
Hannover Medical School
Stellenbosch University
Kobe University
Ankara Üniversitesi
Instituto Mexicano del Seguro Social
Çukurova Üniversitesi
Menoufia University
University Hospital Southampton NHS Foundation Trust
Kasturba Medical College, Manipal
Faculty of Medicine
Hamad Medical Corporation
Nagoya City University Graduate School of Medical Sciences
Pavlov University
Ramathibodi Hospital
Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona
Federal Biomedical Agency Russia
Hospital Universitario Río Hortega
CHU Mohammed-VI
Sengkang General Hospital
Military Medical Academy, Sofia
Kantonsspital Frauenfeld
MGM Medical College, Aurangabad
King Fahd General Hospital
European Association of Urology
Saint-Petersburg State University Hospital
Istanbul Kent University
Jose R. Reyes Memorial Medical Center
Ng Teng Fong General Hospital
Asian Institute of Nephrology and Urology
St. Anna Hospital
Medicana Atasehir Hospital
Santa Casa de Belo Horizonte Hospital
Botkin Hospital
Veterans Memorial Medical Center
Preeti Urology and Kidney Hospital
Ford Hospital and Research Centre
Fortune Urology Clinic
B T Savani Kidney Hospital
Pushpanjali Hospital & Research Centre
Institution Hospital Provincial de Ovalle
National and Kapodistrian University of Athens
Hannover Medical School
Stellenbosch University
Kobe University
Ankara Üniversitesi
Instituto Mexicano del Seguro Social
Çukurova Üniversitesi
Menoufia University
University Hospital Southampton NHS Foundation Trust
Kasturba Medical College, Manipal
Faculty of Medicine
Hamad Medical Corporation
Nagoya City University Graduate School of Medical Sciences
Pavlov University
Ramathibodi Hospital
Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona
Federal Biomedical Agency Russia
Hospital Universitario Río Hortega
CHU Mohammed-VI
Sengkang General Hospital
Military Medical Academy, Sofia
Kantonsspital Frauenfeld
MGM Medical College, Aurangabad
King Fahd General Hospital
European Association of Urology
Saint-Petersburg State University Hospital
Istanbul Kent University
Jose R. Reyes Memorial Medical Center
Ng Teng Fong General Hospital
Asian Institute of Nephrology and Urology
St. Anna Hospital
Medicana Atasehir Hospital
Santa Casa de Belo Horizonte Hospital
Botkin Hospital
Veterans Memorial Medical Center
Preeti Urology and Kidney Hospital
Ford Hospital and Research Centre
Fortune Urology Clinic
B T Savani Kidney Hospital
Pushpanjali Hospital & Research Centre
Institution Hospital Provincial de Ovalle
Corresponding Author(s)
Other Contributor(s)
Abstract
Background and objective: The optimal patient position for percutaneous nephrolithotomy (PCNL) remains a matter of debate. Our aim was to evaluate the association between prone versus supine positioning and perioperative and postoperative outcomes of suction mini-PCNL. Methods: In this prospective multicenter observational study, we analyzed data for 1534 patients treated in 30 centers between March and November 2024. Outcomes included the stone-free rate (SFR) assessed via 30-d computed tomography, and complication rates. Multivariable analysis was used to assess the effect of prone positioning on stone-free status (zero fragments) and overall complications, with adjustment for other covariates. Key findings and limitations: There were 653 patients (43%) in the prone group and 881 (57%) in the supine group. Patient demographics were similar between the groups, except for body mass index. In terms of Guy's stone score, the prone group had a higher proportion of score 1 stones (60% vs 47%) and the supine group a higher proportion of score 4 stones (6.9% vs 3.2%). Median stone volume did not differ significantly, at 1636 mm<sup>3</sup> in the supine group and 1725 mm<sup>3</sup> in the prone group (p = 0.7). The prone group had more frequent use of spinal anesthesia (68% vs 29%; p < 0.001), fluoroscopy-only guidance (86% vs 61%; p < 0.001), and supracostal access (36% vs 22%; p < 0.001). Surgical time, pain scores, hospital length of stay, and readmission rates were similar between the groups. Zero-fragment stone-free rates were comparable (85% prone vs 81% supine; p = 0.052). Prone position was associated with higher rates of blood transfusion (2.8% vs 0%; p < 0.001), renal pelvic perforation (2.8% vs 0.23%; p < 0.001), and pneumothorax (1.5% vs 0%; p < 0.001). Multivariable analysis revealed that prone positioning was not significantly associated with grade A stone-free status (odds ratio 0.92, 95% confidence interval [CI] 0.66–1.29; p = 0.6) or the overall complication rate (odd ratio 0.87, 95% CI 0.59–1.28; p = 0.5). The nonrandomized study design may have introduced selection bias and limited our ability to establish causal relationships between variables. Conclusions and clinical implications: Both prone and supine positioning for PCNL achieved excellent SFRs with acceptable safety profiles.