Abstract / Summary
Abstract Background: Percutaneous nephrolithotomy (PCNL) is standard treatment for large renal calculi. Prone PCNL remains established, while supine PCNL offers anesthetic advantages; comparative data during initial institutional adoption remain limited, particularly from Indian centers. Objective: To compare perioperative outcomes between prone and supine PCNL, our initial supine adoption experience. Methods: This single-center retrospective cohort study at a tertiary care center included 167 patients: 84 prone (Group A), 83 supine (Group B). All underwent CT urography preoperatively. Primary outcomes were stone-free rate, operative time, hospital stay, and Clavien-Dindo grade complications. Results: Supine patients had marginally higher BMI (27.6±3.7 vs 27.3±2.8 kg/m²; p=0.457). Prone stones were larger (median 3.4 vs 2.6 cm; p<0.001) with higher Guy’s Stone Scores (p=0.002). Lower/inferior calyceal puncture predominated in both groups (73.8% prone, 96.4% supine). Stone-free rates were comparable (84.5% vs 83.1%; p=0.836). Operative time was longer in prone patients (97.0 vs 60.0 min; p<0.001); fluoroscopic dose was higher in supine patients (57.10 vs 43.95 mGy; p<0.001). Hospital stay was shorter with supine PCNL (2 vs 3 days; p<0.001); Grade 1 Complications were more frequent in Prone Group (19.0 vs 4.8 %; p=0.007) renal vascular injury requiring angioembolization occurred in two patients per group, all resolved without nephrectomy, plus one conservative liver injury. In the propensity-matched sensitivity analysis(n=35), operative time remained longer in the prone group and radiation dose remained higher in the supine group, although residual covariate imbalance persisted. Conclusion: Supine PCNL achieves stone clearance and safety comparable to prone PCNL, with shorter hospital stay. Larger prospective, complexity-matched studies are warranted.