Contralateral knee-flexion prone split-leg percutaneous nephrolithotomy: A versatile technique

Abstract Background Traditional prone position (TP) and prone split-leg position are two commonly used operative positions for percutaneous nephrolithotomy (PCNL). However, when confronting with the situation of endoscopic combined intrarenal surgery, the former could not avoid the need of position change while the latter requires flexible retrograde ureteroscopy (fURS) with higher cost. The current study optimized a novel technique for performing percutaneous nephrolithotomy (PCNL) in the knee-flexion prone split-leg position (KF-PSL)and evaluated the safety, advantages, and feasibility compare to the traditional prone position (TP). Methods An evolution of technique based on common prone split-leg position (PSL) was presented, and a retrospective analysis was conducted on the data of 105 patients who underwent PCNL in KF-PSL or TP position between January 2021 and June 2021. The demographic and preoperative clinical data of the KF-PSL and TP groups were reviewed, and the preoperative, perioperative, and postoperative parameters were compared. Results The perioperative manifestations of 51 patients who underwent PCNL in the KF-PSL position and 54 patients in the TP position were analyzed. The preoperative parameters of the two groups did not differ significantly. The mean stone size was 43.38±29.64 mm in maximum diameter. S.T.O.N.E. scores greater than 11 accounted for 11.4%. The mean operative time (85.4±47.7 mins in KF-PSL vs 109.6±48.9 mins in TP) was a significant index (P<0.001). Both groups had similar stone-free rates after four weeks (P=0.134). Three cases of endoscopic combined intrarenal surgery were performed in the KF-PSL group. The Braden scale scores of the two groups did not differ significantly(P=0.686). No significant difference was observed between the groups in the total complication rate(P=1). Conclusion The KF-PSL is a promising novel position that allows a shorter operative time and more simplified surgical procedure for PCNL than TP without compromising the outcome. It is more convenient for combined therapy, which allows access to the entire urinary tract without the need for changing position. KF-PSL is a safe, efficient, and versatile position that enables the complete resolution of large stones in a single procedure. Trial registration ChiCTR2200055385, 8th, January, 2021.