K.WANG1, J.J.LEOW2, J.C.H.FOO3, Y.YEOW2, Y.M.LEE2
Nanyang Technological University1, Tan Tock Seng Hospital2, Sengkang General Hospital3
Contemporary practice guidelines recommend the prone and supine positions for PCNL. Despite numerous studies comparing the two, no clear consensus has been reached regarding the best position for optimal outcomes. This meta-analysis was conducted to assess the efficacy and safety of PCNL in the supine position compared to the prone position, when performed on patients with renal or upper ureteric stones.
In March 2021, a systematic review was conducted on the digital databases PubMed, EMBASE and the Cochrane Central Register of Controlled Trials according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. The Cochrane Collaboration Risk of Bias 2 tool was used to assess randomised controlled trials, and the Newcastle-Ottawa Scale was used for non-randomised prospective and retrospective cohort studies.
Thirty-five publications, consisting of 10,230 patients, were selected for inclusion in this analysis. There were no significant differences in stone-free rate (p=0.80) and duration of hospitalisation (p=0.13) between supine and prone PCNL. However, supine PCNL had a shorter operating time (WMD -12.0 min, 95% CI -18.4 to -5.5, p=0.001), lower total complication rate (RR 0.83, 95% CI 0.75 to 0.91, p<0.001), fewer blood transfusions (RR 0.77, 95% CI 0.64 to 0.93, p=0.007) and lower post-operative fever rates (RR 0.74, 95% CI 0.62 to 0.88, p=0.001) than the prone group.
Evidence suggests supine PCNL was as effective as, and safer, than prone PCNL. PCNL in the supine position should be considered for patients with renal or upper ureteric stones larger than 2cm.