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Split-leg modified lateral versus prone position in percutaneous nephrolithotomy: a prospective, randomized trial

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Abstract

Purpose

Standard prone position (PP) during percutaneous nephrolithotomy (PNL) has multiple drawbacks. We aimed to compare PNLs performed in split-leg (SL) modified lateral position (MLP) and those performed in standard PP.

Methods

A prospective, randomized, unblind, double arm trial was conducted at a tertiary care academic medical center in Egypt, between November 2017 and October 2019. Adult patients with renal stones undergoing PNL were included. According to renal anatomy and stone complexity, stratified randomization was performed and study participants were allocated into either SL-MLP group or PP group. The stone free rate (SFR), total operative time, track formation time, fluoroscopy time, auxiliary procedures, and complications were compared.

Results

There were 61 patients in SL-MLP group and 63 patients in PP group. Both groups had similar baseline characteristics. The SFR was comparable between groups: 75.4% in SL-MLP group and 77.8% in PP group (p = 0.755). The mean total operative time was shorter and mean track formation time was longer in SL-MLP group (55.33 ± 20.73 vs. 98.49 ± 9.23, p < 0.001 and 7.89 ± 3.68 vs. 6.52 ± 1.77, p = 0.002). There was no significant difference in fluoroscopy time, total complication rates, hemoglobin reduction and need for blood transfusion between the groups. In SL-MLP group, all PNL procedures as well all the associated procedures were performed with the patients in the same position.

Conclusion

SL-MLP PNL has a short operative time and similar SFR and complication rate compared to PP PNL. SL-MLP allowed antegrade and retrograde access to the urinary tract without patient repositioning.

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Author information

Authors and Affiliations

  1. Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

    Abul-fotouh Ahmed, Ahmed Gomaa, Abdullah Daoud, Ahmed Solyman, Hassan Abdelazim, Mohammed El-feky, Mohammed Agha, Ashraf Abdellatif & Ahmed Fahim

  2. Department of Urology, Saudi German Hospital, Asir, Saudi Arabia

    Mohammed Agha

  3. Department of Urology, Al-Hamady Hospital, Riyadh, Saudi Arabia

    Ashraf Abdellatif

Authors
  1. Abul-fotouh Ahmed
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  2. Ahmed Gomaa
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  3. Abdullah Daoud
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  4. Ahmed Solyman
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  5. Hassan Abdelazim
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  6. Mohammed El-feky
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  7. Mohammed Agha
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  8. Ashraf Abdellatif
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  9. Ahmed Fahim
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Contributions

AA-F: protocol development, data collection, data analysis, manuscript writing; GA: protocol development, data collection; DA: protocol development, data collection; SA: protocol development, data collection; AH: data collection; E-FM: data collection; AM: data collection; AA: data analysis, manuscript writing; FA: protocol development, manuscript writing. They all approved the final version of the manuscript.

Corresponding author

Correspondence to Abul-fotouh Ahmed.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Research Ethics Committee of the Urology Department, Al-Azhar University, Cairo, Egypt. Reference Number: Uro_Azhar_12_017 (SRCTN75387858). All procedures performed in the present study involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from each participant included in the study.

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Ahmed, Af., Gomaa, A., Daoud, A. et al. Split-leg modified lateral versus prone position in percutaneous nephrolithotomy: a prospective, randomized trial. World J Urol 39, 1247–1256 (2021). https://doi.org/10.1007/s00345-020-03285-x

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  • DOI: https://doi.org/10.1007/s00345-020-03285-x

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