Taha Diaa-Eldin, Ibrahim Ali, Zeid Ahmed, Shokry Eslam, Abdelbaky Tarek, Nabeeh Hossam
Department of Urology, College of Medicine, Kafrelsheikh University, Kafr El-Sheikh, Egypt.
Urol Ann. 2025 Jan-Mar;17(1):32-37. doi: 10.4103/ua.ua_36_24. Epub 2025 Jan 18.
The aim of this study intends to assess prone and flexed prone positions for percutaneous nephrolithotomy (PNL) for safety and efficacy.
From May 2017 to August 2022, a stratified randomized approach was carried out to randomly assign 346 PNL candidates into prone or flexed prone groups. Perioperative data, such as stone-free rate, stay length, operative time, and complication rates, were studied.
In the prone and flexed prone groups, the mean ages of 51.7 ± 12.2 and 49.4 ± 11.9 min, respectively ( = 0.1). The mean body mass indexes of 24.2 ± 13.4 and 29.9 ± 11.9, respectively ( = 0.03). The pyelocaliceal perforation occurred in 15 (8%) and 11 (6.4%) participants, respectively. In the prone and flexed prone postures, postoperative bleeding occurred in 15 (7.9%) and 9 (5.4%) patients, respectively ( = 1.0). The average percentage decrease in hemoglobin concentration was 1.29 ± 0.42 and 1.21 ± 0.32, respectively ( < 0.000). The success rates were 92 and 93.6%, respectively ( = 0.6). The average access length was 3.9 ± 1.2 and 4.8 ± 1.8 min ( = 0.08), whereas the average operation duration was 68.7 ± 37.4 and 50.4 ± 21.9 min ( = 0.04).
Both the prone and prone-flexed positions are equally safe for PNL. The flexed prone position is more likely to be beneficial for obese patients. The prone-flexed position enabled a somewhat shorter average operation time. The pelvicalyceal system could be more readily reached when the prone position was flexed.
本研究旨在评估经皮肾镜取石术（PNL）中俯卧位和屈膝俯卧位的安全性和有效性。
2017年5月至2022年8月，采用分层随机方法将346例PNL候选患者随机分为俯卧位组或屈膝俯卧位组。研究围手术期数据，如结石清除率、住院时间、手术时间和并发症发生率。
在俯卧位组和屈膝俯卧位组中，平均年龄分别为51.7±12.2岁和49.4±11.9岁（P=0.1）。平均体重指数分别为24.2±13.4和29.9±11.9（P=0.03）。肾盂肾盏穿孔分别发生在15例（8%）和11例（6.4%）参与者中。在俯卧位和屈膝俯卧位姿势下，术后出血分别发生在15例（7.9%）和9例（5.4%）患者中（P=1.0）。血红蛋白浓度平均下降百分比分别为1.29±0.42和1.21±0.32（P<0.000）。成功率分别为92%和93.6%（P=0.6）。平均穿刺通道建立时间分别为3.9±1.2分钟和4.8±1.8分钟（P=0.08），而平均手术时间分别为68.7±37.4分钟和50.4±21.9分钟（P=0.04）。
俯卧位和屈膝俯卧位在PNL中同样安全。屈膝俯卧位对肥胖患者可能更有益。屈膝俯卧位使平均手术时间有所缩短。屈膝俯卧位时肾盂肾盏系统更容易到达。
