Etienne X Keller1, Vincent DE Coninck2, Silvia Proietti3, Michele Talso4, Esteban Emiliani5, Achilles Ploumidis6, Guglielmo Mantica7, Bhaskar Somani8, Olivier Traxer9, Roberto M Scarpa10, Francesco Esperto10. 1. Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland - etienne.xavier.keller@gmail.com. 2. Department of Urology, AZ Klina, Brasschaat, Belgium. 3. Department of Urology, Ville Turro Division, European Training Center for Endourology, IRCCS San Raffaele Hospital, Milan, Italy. 4. Department of Urology, Hospital of Vimercate, Vimercate, Monza-Brianza, Italy. 5. Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain. 6. Department of Urology, Athens Medical Group, Athens, Greece. 7. Department of Urology, IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy. 8. University Hospital Southampton NHS Trust, University of Southampton, Southampton, UK. 9. Department of Urology, Sorbonne University, GRC N. 20 Lithiase Urinaire, Hospital Tenon AP-HP, Paris, France. 10. Department of Urology, Campus Bio-Medico University, Rome, Italy.
Abstract
INTRODUCTION: 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. EVIDENCE ACQUISITION: 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. EVIDENCE SYNTHESIS: 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). CONCLUSIONS: 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.
INTRODUCTION: 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. EVIDENCE ACQUISITION: 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. EVIDENCE SYNTHESIS: 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). CONCLUSIONS: 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.
Authors: Davide Perri; Lorenzo Berti; Andrea Pacchetti; Elena Morini; Matteo Maltagliati; Umberto Besana; Antonio Luigi Pastore; Javier Romero-Otero; Giovanni Saredi; Danilo Centrella; Maria Chiara Sighinolfi; Bernardo Rocco; Salvatore Micali; Paolo Broggini; Marco Boldini; Federica Mazzoleni; Giorgio Bozzini Journal: World J Urol Date: 2022-08-27 Impact factor: 3.661