Introduction
Since its first description by Fernstrom and Johansson in 1976 [1], percutaneous nephrolithotomy (PCNL) has become the standard endoscopic treatment for large and complex renal calculi, replacing open surgical removal. Traditionally, the prone position was considered the only position to obtain renal access due to increased concerns of colonic and vascular injury associated with alternative positions.
In 1987, Valdivia Urìa et al. [2] presented the supine PCNL and described the advantages of this ‘simplified’ technique. Over two decades later, interest in supine PCNL has only just begun to rise significantly. A study by the Endourological Society found that 80.3% of patients were operated in the prone position compared with 19.7% in the supine position [3].
Variations of the PCNL technique, including mini-PCNL, ultra-mini-PCNL and tubeless-PCNL, have been described with the aim of reducing patients’ morbidity.
There is still controversy over the optimal position and technique to perform PCNL, and an overall consensus has yet to be reached. We review prone and supine PCNL and their benefits and disadvantages