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World J Urol. 2013 Oct;31(5):1225-30. doi: 10.1007/s00345-012-0889-y. Epub 2012 Jun 13.

A study on comparative outcomes of percutaneous nephrolithotomy in prone, supine, and flank positions.

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Urology and Nephrology Research Center (UNRC), Shohada Medical Center, Shahid Beheshti University, M.C. (SBMU), No. 103, Boostan 9th St., Pasdaran Ave., P.O.Box: 1666677951, Tehran, I.R. Iran,



To compare percutaneous nephrolithotomy (PCNL) safety and efficacy in prone, supine, and flank positions.


A total number of 150 candidates for PCNL were randomly assigned into prone, supine, and flank groups. Patients in groups 1 and 2 underwent fluoroscopy-guided PCNL in prone and supine positions, respectively, while patients in group 3 underwent ultrasonography-guided PCNL in lateral position.


The success rates were 92, 86, and 88 % in prone, supine, and flank positions, respectively (P = 0.7). The mean access duration was 6.9 ± 4.2, 11.1 ± 5.8, and 10.8 ± 4.1 min (P = 0.08), and the mean operation time was 68.7 ± 37.4, 54.2 ± 25.1 and 74.4 ± 26.9 min (P = 0.04) in prone, supine, and flank groups, respectively. Pyelocaliceal perforation occurred in 2 (4 %), 2 (4 %), and 3 (6 %) patients in prone, supine, and flank positions, respectively (P = 1).


We believe that PCNL in both supine and flank positions are as safe and relatively effective as prone position in experienced hands. Preference of the surgeon and proper case selection for each procedure is very important and necessary.

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