Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2012 Sep;10(3):307-16.
doi: 10.1016/j.aju.2012.06.005. Epub 2012 Aug 11.

Positions for percutaneous nephrolithotomy: Thirty-five years of evolution

Theocharis Karaolides  1 , Konstantinos Moraitis  2 , Christian Bach  1 , Junaid Masood  1 , Noor Buchholz  1
Affiliations
Review

Positions for percutaneous nephrolithotomy: Thirty-five years of evolution

Theocharis Karaolides et al. Arab J Urol. 2012 Sep.

Abstract

Objectives: To present the chronological development of the different positions described for percutaneous nephrolithotomy (PCNL), in an attempt to identify the reasons for their development and to highlight their specific advantages and disadvantages.

Methods: Previous reports were identified by a non-systematic search of Medline and Scopus.

Results: The classic prone position for PCNL was first described in 1976. The technique was gradually standardised and PCNL with the patient prone became the generally accepted standard approach. In the next 35 years many other positions were described, with the patient placed prone, lateral or supine in various modifications. Modifications of the classic prone position in the early 1990s aimed to provide the option of a simultaneous retrograde approach during the procedure. As PCNL became more popular the lateral position was first described in 1994, to allow the application of PCNL to patients who were unable to tolerate being prone because of their body habitus. The supine position for percutaneous access was originally described even before 1990, but become more popular after 2007 when the Galdakao modification was reported. Several other modifications of the supine position have been described, with the latest being the flank-free modified supine position, which allows the best exposure of the flank among the supine positions. Each position has its specific advantages and disadvantages.

Conclusion: Urologists who perform PCNL should be familiar with the differences in the positions and be able to use the method appropriate to each case.

Keywords: Endoscopic intrarenal surgery; Flank; Lateral; PCNL; PCNL, percutaneous nephrolithotomy; Perctutaneous nephrolithotomy; Positions; Prone; Supine.

PubMed Disclaimer

Figures

Figure 1
Figure 1
The prone position.
Figure 2
Figure 2
The Montreal mattress, with the Proneview helmet.
Figure 3
Figure 3
The split-leg position. (Taken from with permission from the author, courtesy of Professor Michael Grasso).
Figure 4
Figure 4
The prone-flexed position. (Taken from with permission from the author, courtesy of Dr. R. John D’A. Honey).
Figure 5
Figure 5
‘The Barts technique’.
Figure 6
Figure 6
The ‘Valdivia’ supine position (courtesy of Professor José Gabriel Valdivia Uría).
Figure 7
Figure 7
The modified ‘Valdivia’ position (courtesy of Professor José Gabriel Valdivia Uría).
Figure 8
Figure 8
The Galdakao-modified Valdivia position (courtesy of Dr. Cesare Marco Scoffone).
Figure 9
Figure 9
The complete supine position. (Taken from with permission from the author, courtesy of Dr. Siavash Falahatkar, Professor of Urology).
Figure 10
Figure 10
The Barts flank-free supine position.
None
See this image and copyright information in PMC

References

    1. Fernstrom I., Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol. 1976;10:257–259. - PubMed
    1. Nord R.C.-G.A., Bagley D.H. Prone split-leg position for simultaneous retrograde ureteroscopic and percutaneous nephroscopic procedures. J Endourol. 1991;5:13–16.
    1. Grasso M., Nord R., Bagley D.H. Prone split-leg and flank roll positioning: simultaneous antegrade and retrograde access to the upper urinary tract. J Endourol. 1993;7:307–310. - PubMed
    1. Kerbl K., Clayman R.V., Chandhoke P.S., Urban D.A., De Leo B.C., Carbone J.M. Percutaneous stone removal with the patient in a flank position. J Urol. 1994;151:686–688. - PubMed
    1. Neto E.A., Mitre A.I., Gomes C.M., Arap M.A., Srougi M. Percutaneous nephrolithotripsy with the patient in a modified supine position. J Urol. 2007;178:165–168. - PubMed