WANG Jing 1 , GAO Mengxin 1 , CHEN Yuqin 1 , CHEN Yuan 1 , LIU Chunxiang 2 , ZHANG Min 3 , LIU Yongda 4 , SUN Hongling 2
  • 1. School of Nursing, Guangzhou Medical University, Guangzhou 510000, P. R. China;
  • 2. Department of Nursing, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, P. R. China;
  • 3. Haiyin Operating Room, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, P. R. China;
  • 4. Department of Urology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, P. R. China;
SUN Hongling, Email: haiyinshoushushi@sina.cn
Operative position; Percutaneous nephrolithotomy; Network meta-analysis; Randomized controlled trials
10.7507/1672-2531.202501103
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Objective To systematically review the efficacy of different positions on the clinical outcomes of percutaneous nephrolithotomy (PCNL). Methods The PubMed, Web of Science, EBSCOhost, Cochrane Library, Embase, CNKI, WanFang Data, VIP, and CBM databases were electronically searched to collect randomized controlled trials (RCTs) related to the objects from January 2014 to April 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies, a network meta-analysis was conducted using Stata 18.0 software. Results A total of 54 RCTs involving 5 092 patients and 7 different positions were included. The results of the best probability ranking showed that for positioning time, the split-leg prone position required the shortest time, while the traditional prone position required the longest. For access establishment time, the recumbent lithotomy position had the shortest duration, and the traditional prone position the longest. Intraoperative blood loss was lowest in the supine position and highest in the traditional prone position. Surgical duration was shortest for the recumbent lithotomy position and longest for the traditional prone position. Postoperative hospital stay was shortest for the supine position and longest for the traditional prone position. Complication rates were lowest for the oblique supine position and highest for the traditional prone position. Stone clearance rates were highest for the modified curved prone position and lowest for the traditional prone position. Conclusion  Current evidence shows that different body positions have different clinical effects on percutaneous nephrolithotomy. The recumbent lithotomy position may optimize access establishment and surgical duration, while the supine position offers advantages in reducing intraoperative blood loss and shortening postoperative hospitalization. The split-leg prone position minimizes positioning time, the oblique supine position lowers complication rates, and the modified curved prone position maximizes stone clearance. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

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