Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland -
Department of Urology, AZ Klina, Brasschaat, Belgium.
Minerva Urol Nephrol. 2021 Feb;73(1):50-58. doi: 10.23736/S2724-6051.20.03960-0. Epub 2020 Oct 5.
Percutaneous nephrolithotomy (PNL) can be performed either in prone or supine position. This study aimed at gathering together randomized controlled trials (RCTs) comparing efficacy and safety between prone and supine PNL.
Systematic review of literature was conducted using the Scopus, Medline and Web of Science databases. Study selection, data extraction and quality assessment were independently assessed by two authors. Meta-analysis was performed with Review Manager 5.3. Sensitivity analyses were performed to exclude studies with high risk of bias.
Pooled data from 12 studies including 1290 patients were available for analysis. Only one study was found to have overall low risk of bias. Significantly shorter operative time was found in favor of supine PNL (mean difference 13 minutes, 95% confidence interval [CI]: 3.4-22.7; P<0.01). Stone-free rate (SFR)≥14 days after surgery was significantly higher in prone PNL (odds ratio [OR]=2.15, 95% CI: 1.07-4.34; P=0.03). Significantly higher fever rate was found in prone PNL (OR=1.60, 95% CI: 1.03-2.47; P=0.04). Overall SFR, hospital stay length, complications rate, transfusions rate and blood loss, as well as non-lower calyx puncture rate, puncture attempts and tubeless intervention rate did not differ between prone and supine PNL (P>0.05).
Efficacy of PNL seems balanced between prone and supine position, with comparable overall SFR and shorter operative time in favor of supine PNL. Safety of PNL appears in favor of supine PNL, with lower fever rate. Because of study heterogeneity and possible risks of outcome bias, results from this study should be interpreted with caution. Altogether, both prone and supine PNL account for appropriate therapy options.
经皮肾镜碎石术（PNL）可采用俯卧位或仰卧位进行。本研究旨在收集比较俯卧位和仰卧位 PNL 疗效和安全性的随机对照试验（RCT）。
系统检索 Scopus、Medline 和 Web of Science 数据库中的文献。两名作者独立进行研究选择、数据提取和质量评估。使用 Review Manager 5.3 进行荟萃分析。进行敏感性分析以排除偏倚风险高的研究。
共纳入 12 项研究，包括 1290 例患者，可进行数据分析。仅一项研究被发现整体偏倚风险低。仰卧位 PNL 的手术时间明显缩短（平均差异 13 分钟，95%置信区间 [CI]：3.4-22.7；P<0.01）。俯卧位 PNL 的术后 14 天结石清除率（SFR）≥14 天的比例明显更高（比值比 [OR]=2.15，95% CI：1.07-4.34；P=0.03）。俯卧位 PNL 的发热率明显较高（OR=1.60，95% CI：1.03-2.47；P=0.04）。总体 SFR、住院时间长短、并发症发生率、输血率和出血量以及下盏穿刺率、穿刺次数和无管化干预率在俯卧位和仰卧位 PNL 之间无差异（P>0.05）。
PNL 的疗效在俯卧位和仰卧位之间似乎平衡，仰卧位 PNL 的总体 SFR 更高，手术时间更短。PNL 的安全性似乎有利于仰卧位 PNL，发热率较低。由于研究异质性和结局偏倚的潜在风险，应谨慎解释本研究的结果。总之，俯卧位和仰卧位 PNL 都是合适的治疗选择。
