Hemodynamic Effects of Surgical Position in Prone vs. Supine Percutaneous Nephrolithotomy
The Effect of Surgical Position on Hemodynamics in Percutaneous Nephrolithotomy Performed in Prone and Supine Positions
Gaziosmanpasa Research and Education Hospital
84 participants
Jun 1, 2025
INTERVENTIONAL
Conditions
Summary
This prospective, randomized controlled study evaluates the hemodynamic effects of prone and supine positions during percutaneous nephrolithotomy (PNL) for large kidney stones. Surgical position may influence intraoperative and postoperative hemodynamic stability. Prone positioning can increase intrathoracic pressure and reduce venous return, whereas supine positioning may provide greater hemodynamic stability. A total of 84 patients will be randomized to undergo PNL in prone or supine positions. Primary outcomes include changes in hemodynamic parameters during surgery. Results may guide surgical position selection, especially in patients with potential hemodynamic risk.
Eligibility
Inclusion Criteria2
- ASA physical status I-III
- Presence of renal calculi indicated for PNL
Exclusion Criteria8
- Pregnancy
- Uncontrolled coagulopathy
- Previous renal surgery
- Severe cardiac, pulmonary, or neurological disease
- Preoperative urinary tract infection (non-sterile urine culture)
- Surgery duration \<60 minutes or \>120 minutes
- Preoperative blood transfusion
- Multiple access tracts
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Interventions
Patients in this arm will undergo percutaneous nephrolithotomy (PNL) in the prone position. The procedure begins with ureteral catheter placement in lithotomy position, followed by prone positioning for renal access under C-arm fluoroscopic guidance. Stone fragmentation will be performed using pneumatic or ultrasonic lithotripters, and nephrostomy placement will be completed according to standard protocol.
Patients in this arm will undergo percutaneous nephrolithotomy (PNL) in the Galdakao-modified Valdivia supine position. Following general anesthesia, the ipsilateral side will be elevated 20-30°, with the ipsilateral leg extended and the contralateral leg abducted. Ureteral catheter placement will be followed by renal access under C-arm fluoroscopy. Stone fragmentation and removal will be performed using the same standardized lithotripsy and irrigation protocols as in the prone group.
Locations(1)
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NCT07138872