History and present of the differences between the prone and supine position in percutaneous nephrolithotomy

Abstract

The prone position has been considered the principal for percutaneous access to the kidney during the past 25 years; while the Valdiviàs supine position has recently begun to gain acceptance, although it was originally described in the 1980. Even more recently, the position supine of Valdivia - Galdakao - was described. However, there is no consensus on which is the best position for percutaneous nephrolithotomy and the choice is currently based on the surgeon’s preference. This article aims to review the evidence on both surgical techniques and elements give the reader to make decisions. There is no difference in the success rate, defined as free rate calculation between the prone and supine positions. Prone increased risk of bleeding and need for transfusions and longer surgical time. The supine position has been described as safer in patients with obesity, restrictive lung disease, anatomical bone abnormalities and urinary tract malformations.