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Flank versus prone position in percutaneous nephrolithotomy: a meta-analysis of randomized controlled studies

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Abstract

The objective of this study is to assess the safety and efficacy of the flank position in percutaneous nephrolithotomy (PCNL). We searched PubMed, Embase, SCOPUS, the Cochrane database libraries, and the Chinese Biomedical Literature Database, and randomized controlled trials (RCTs) assessing PCNL in flank position are included in this meta-analysis. The related trials met the inclusion criteria were analyzed using RevMan 5.4. Seven randomized controlled trials were included, involving a total of 587 patients. We found that there was a lower decrease in hemoglobin levels in the flank position group compared to prone-position group (mean difference [MD] = − 0.15, 95% confidence interval (CI) − 0.22 to − 0.08, P < 0.00001). Moreover, our meta-analysis demonstrated no significant differences between groups regarding stone-free rate (relative risk [RR] = 1.00, 95% CI 0.93 to 1.06, P = 0.92), operative time(MD = 0.76, 95% CI − 5.31 to 6.83, P < 0.00001), hospital stay (MD = 0.03, 95% CI − 0.32 to 0.32, P < 0.00001), and complications Clavien grade I (RR = 1.01, 95% CI 0.98 to 1.05, P = 0.54), Clavien grade II (RR = 1, 95% CI 0.97 to 1.02, P = 0.78), and Clavien grade III (RR = 1, 95% CI 0.98 to 1.03, P = 0.77). The use of flank position for PCNL is associated with reduced hemoglobin change without an increase in complications. This positioning technique can be considered safe for patients with nephrolithiasis and may be particularly suitable for high-risk individuals such as those who are obese or have decreased cardiopulmonary function. However, further randomized trials are needed to confirm these findings.

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All data generated or analyzed during this study are included in this article. Further enquiries can be directed to the corresponding author.

References

  1. Assimos D, Krambeck A, Miller NL et al (2016) Surgical management of stones: Americal Urological Association/Endourological Society Guidelines, part II. J Urol 196:1161

    Article  PubMed  Google Scholar 

  2. Alsyouf M, Abourbih S, West B et al (2018) Elevated renal pelvic pressuresduring percutaneous nephrolithotomy risk higher postoperative pain and longer hospital stay. J Urol 199:193–199

    Article  PubMed  Google Scholar 

  3. Dalkilinc Hokenek U, Arslan G, Ozcan T, Sayin Kart J et al (2023) Comparison of hemodynamic and respiratory outcomes between two surgical positions for percutaneous nephrolithotomy: a prospective, randomized clinical trial. Actas Urol Esp (Engl Ed) 47(8):509–516

    Article  CAS  PubMed  Google Scholar 

  4. Hosseini SR, Fatahi B, FakhrYasseri AM (2022) Comparison outcomes of percutaneous nephrolithotomy in prone and flank position in obese patients: a randomized clinical trial. Urologia 89(4):580–584. https://doi.org/10.1177/03915603211035588

    Article  PubMed  Google Scholar 

  5. Radfar MH, Nasiri M, Shemshaki H, Sarhangnejad R, Dadpour M (2021) A study on comparative outcomes of totally ultrasonography-guided percutaneous nephrolithotomy in prone versus flank position: a randomized clinical trial. World J Urol 39(11):4241–4246. https://doi.org/10.1007/s00345-021-03744-z

    Article  CAS  PubMed  Google Scholar 

  6. Yu X, Deng H, Li J et al (2020) Clinical efficacy and safety discussion of flank-suspended half lithotomy position percutaneous nephrolithotomy in the treatment of high-risk patients upper urinary stones. Int J Urol Nephrol 2(40):196–199

    Google Scholar 

  7. Wei P, Shiping W, Huiming Li et al (2018) Flank suspended semi-lithotomy position versus prone position in percutaneous nephrolithotomy: a prospective controlled study. Chin J Min Inv Surg 11(18):964–998

    Google Scholar 

  8. Karami H, Mohammadi R, Lotfi B (2013) A study on comparative outcomes of percutaneous nephrolithotomy in prone, supine, and flank positions. World J Urol 31(5):1225–1230. https://doi.org/10.1007/s00345-012-0889-y

    Article  PubMed  Google Scholar 

  9. Karami H, Rezaei A, Mohammadhosseini M, Javanmard B, Mazloomfard M, Lotfi B (2010) Ultrasonography-guided percutaneous nephrolithotomy in the flank position versus fluoroscopy-guided percutaneous nephrolithotomy in the prone position: a comparative study. J Endourol 24(8):1357–1361

    Article  PubMed  Google Scholar 

  10. Kerbl K, Clayman RV, Chandhoke PS, Urban DA, De Leo BC, Carbone JM (1994) Percutaneous stone removal with the patient in a flank position. J Urol 151(3):686–688

    Article  CAS  PubMed  Google Scholar 

  11. Gofrit ON, Shapiro A, Donchin Y et al (2002) Lateral decubitus position for percutaneous nephrolithotripsy in the morbidly obese or kyphotic patient. J Endourol 16(6):383–386

    Article  PubMed  Google Scholar 

  12. Karami H, Arbab AH, Rezaei A, Mohammadhoseini M, Rezaei I (2009) Percutaneous nephrolithotomy with ultrasonography-guided renal access in the lateral decubitus flank position. J Endourol 23(1):33–35

    Article  PubMed  Google Scholar 

  13. Inanloo SH, Yahyazadeh SR, Ramezani-Binabaj M (2022) Percutaneous nephrolithotomy in horseshoe kidney: comparing ultrasound-guided access in flank position with conventional fluoroscopic-guided in prone position. Urolithiasis 50(6):773–778

    Article  PubMed  Google Scholar 

  14. Basiri A, Ziaee SA, Nasseh H et al (2008) Totally ultrasonography-guided percutaneous nephrolithotomy in the flank position. J Endourol 22(7):1453–1457

    Article  PubMed  Google Scholar 

  15. Liu ZQ, Xie J, Zhao CB et al (2022) Feasibility of contrast-enhanced ultrasound and flank position during percutaneous nephrolithotomy in patients with no apparent hydronephrosis: a randomized controlled trial. World J Urol 40(4):1043–1048

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Jang WS, Choi KH, Yang SC, Han WK (2011) The learning curve for flank percutaneous nephrolithotomy for kidney calculi: a single surgeon’s experience. Korean J Urol 52(4):284–288

    Article  PubMed  PubMed Central  Google Scholar 

  17. Pan T, Liu B, Wei S et al (2015) Flank-suspended versus prone percutaneous nephrolithotomy: changes of haemodynamics, arterial blood gases and subjective feelings. Urologia 82(2):102–105

    Article  PubMed  Google Scholar 

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Author notes

  1. Changjian Zheng and Hongmei Yang have contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, China

    Changjian Zheng & Lin Yang

  2. Department of Rehabilitation Medicine, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, China

    Hongmei Yang

  3. Department of School of Medical Informatics, Chongqing Medical University, Chongqing, 400016, China

    Yalan Lv

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  1. Changjian Zheng
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  4. Lin Yang
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Contributions

Lin yang had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Changjian Zheng. Acquisition of data: Changjian Zheng. Analysis and interpretation of data: Changjian Zheng and Hongmei Yang. Drafting of the manuscript: Changjian Zheng and LinYang. Critical revision of the manuscript for important intellectual content: Changjian Zheng. Statistical analysis: Changjian Zheng and Yalan Lv. Obtaining funding: none. Other (specify): none.

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Correspondence to Lin Yang.

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Zheng, C., Yang, H., Lv, Y. et al. Flank versus prone position in percutaneous nephrolithotomy: a meta-analysis of randomized controlled studies. Urolithiasis 52, 70 (2024). https://doi.org/10.1007/s00240-024-01557-4

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