https://doi.org/10.4081/aiua.2024.12944

Barts flank-free modified supine position vs prone position in percutaneous nephrolithotomy: Systematic review and meta analysis

Early Access
Published: October 29, 2024
barts, flank-free, supine, prone, PCNL
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Authors

I Gede Yogi Prema Ananda
https://orcid.org/0009-0002-5692-1725
Department of Urology, Faculty of Medicine, Universitas Udayana, Denpasar, Bali, Indonesia.
Kadek Budi Santosa
Department of Urology, Faculty of Medicine, Universitas Udayana, Denpasar, Bali; Prof. Dr. I.G.N.G. Ngoerah Hospital, Denpasar, Bali, Indonesia.
I Wayan Yudiana
Department of Urology, Faculty of Medicine, Universitas Udayana, Denpasar, Bali; Prof. Dr. I.G.N.G. Ngoerah Hospital, Denpasar, Bali, Indonesia.
Pande Made Wisnu Tirtayasa
https://orcid.org/0000-0001-5519-1316
Department of Urology, Faculty of Medicine, Universitas Udayana, Denpasar, Bali; Universitas Udayana Teaching Hospital, Badung, Bali, Indonesia.
Ida Bagus Putra Pramana
Department of Urology, Faculty of Medicine, Universitas Udayana, Denpasar, Bali; Universitas Udayana Teaching Hospital, Badung, Bali, Indonesia.
Nyoman Gede Prayudi
Department of Urology, Faculty of Medicine, Universitas Udayana, Denpasar, Bali; Prof. Dr. I.G.N.G. Ngoerah Hospital, Denpasar, Bali, Indonesia.
Gede Wirya Kusuma Duarsa
gwkduarsa@yahoo.com
Department of Urology, Faculty of Medicine, Universitas Udayana, Denpasar, Bali; Prof. Dr. I.G.N.G. Ngoerah Hospital, Denpasar, Bali, Indonesia.

Introduction: Percutaneous Nephrolithotomy (PCNL) has been performed in various positions, including prone position and several modifications of supine position. The Barts flank-free modified supine (FFMS) position is a newly enhanced version of the supine positions. This study aims to compare the outcomes of Barts FFMS and prone position in PCNL.
Methods: This study followed PRISMA 2020 guideline and was registered to PROSPERO CRD42024530426. Comprehensive search in PubMed, Sciencedirect, and Scopus was conducted until May 2024. Stone-free rates, complications, surgery duration, fluoroscopy duration, use of nephrostomy, and length of stay were collected. Data were analyzed using RevMan 5.4.
Results: A total of 4 studies were included in this review. There was no significant difference in stone-free rates between Barts FFMS and prone positions (OR = 1.12, 95% CI 0.64-1.95, p = 0.70). There were no significant difference in incidence of fever (OR = 0.91, 95% CI 0.38-2.18, p = 0.84), need for blood transfusion (OR = 0.46, 95% CI 0.11-1.88, p = 0.28), and urine leakage (OR = 0.41, 95% CI 0.16-1.05, p = 0.06). The surgery duration was significantly shorter in Barts FFMS position than in prone position (MD = -15.48, 95% CI [(-26.42)-(-4.55)], p = 0.006). There was no significant difference in patients requiring nephrostomy (OR = 0.19, 95% CI 0.01-3.75, p = 0.28). There were no significant difference in fluoroscopy duration (MD = 0.27, 95% CI [(-6.85)-7.40], p = 0.94) and the length of hospital stay (MD = -0.20, 95% CI [(-0.74)-0.33], p = 0.46).
Conclusions: The surgery duration was significantly shorter in Barts FFMS position than in prone position. There were no significant differences regarding stone-free rates, complications, fluoroscopy duration, use of nephrostomy, and length of hospital stay. This indicates that neither Barts FFMS nor prone position is superior, and the choice should be based on the surgeon's preference and the patient's clinical status.

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Google Scholar
Europe PMC
Alelign T, Petros B. Kidney Stone Disease: An Update on Current Concepts. Adv Urol. 2018; 2018:3068365. DOI: https://doi.org/10.1155/2018/3068365
Sorokin I, Mamoulakis C, Miyazawa K, et al. Epidemiology of stone disease across the world. World J Urol. 2017;35:1301-1320. DOI: https://doi.org/10.1007/s00345-017-2008-6
Zhang L, Zhang X, Pu Y, et al. Global, Regional, and National Burden of Urolithiasis from 1990 to 2019: A Systematic Analysis for the Global Burden of Disease Study 2019. Clin Epidemiol. 2022;14:971-983. DOI: https://doi.org/10.2147/CLEP.S370591
Edvardsson VO, Indridason OS, Haraldsson G, et al. Temporal trends in the incidence of kidney stone disease. Kidney Int. 2013;83:146-52. DOI: https://doi.org/10.1038/ki.2012.320
Assimos D, Krambeck A, Miller N. Surgical Management of Stones: AUA/Endourology Society Guideline (2016), part II. Journal of Urology 2016; 196: 1-50. DOI: https://doi.org/10.1016/j.juro.2016.05.091
Fernström I, Johansson B. Percutaneous pyelolithotomy. Scand J Urol Nephrol 1976; 10:257-9 DOI: https://doi.org/10.1080/21681805.1976.11882084
Valdivia JG, Valer J, Villarroya S, et al. Why is Percutaneous Nephroscopy Still Performed with the Patient Prone? Journal of Endourology 1990; 4: 269-277. DOI: https://doi.org/10.1089/end.1990.4.269
Valdivia Uría J G, Valle Gerhold J, López López JA, et al. Technique and complications of percutaneous nephroscopy: experience with 557 patients in the supine position. J Urol 1998; 160:1975-1978. DOI: https://doi.org/10.1016/S0022-5347(01)62217-1
Karaolides T, Moraitis K, Bach C, et al. Positions for percutaneous nephrolithotomy: Thirty-five years of evolution. Arab Journal of Urology 2012; 10: 307-316. DOI: https://doi.org/10.1016/j.aju.2012.06.005
Kumar P, Bach C, Kachrilas S, et al. Supine percutaneous nephrolithotomy (PCNL): ’In vogue’ but in which position? BJU International 2012; 110: 1-4. DOI: https://doi.org/10.1111/j.1464-410X.2012.11188.x
Bach C, Goyal A, Kumar P, et al. The Barts 'flank-free' modified supine position for percutaneous nephrolithotomy. Urol Int. 2012;89:365-8. DOI: https://doi.org/10.1159/000341430
Mulay A, Mane D, Mhaske S, et al. Supine versus prone percutaneous nephrolithotomy for renal calculi: Our experience. Curr Urol. 2022; 16:25-29. DOI: https://doi.org/10.1097/CU9.0000000000000076
Miçoogulları U, Kamacı D, Yıldızhan M, et al. Prone versus Barts “flank-free” modified supine percutaneous nephrolithotomy: a match-pair analysis. Turk J Med Sci. 2021; 51:1373-1379. DOI: https://doi.org/10.3906/sag-2011-21
Sohail N, Albodour A, Abdelrahman KM. Percutaneous nephrolithotomy in complete supine flank-free position in comparison to prone position: A single-centre experience. Arab J Urol. 2016; 15:42-47. DOI: https://doi.org/10.1016/j.aju.2016.10.001
Zanaty F, Mousa A, Elgharabawy M, et al. A prospective, randomized comparison of standard prone position versus flank-free modified supine position in percutaneous nephrolithotomy: A singlecenter initial experience. Urol Ann. 2022; 14:172-176. DOI: https://doi.org/10.4103/UA.UA_31_20
Proietti S, Rodríguez-Socarrás ME, Eisner B, et al. Supine percutaneous nephrolithotomy: tips and tricks. Transl Androl Urol. 2019; 8:S381-S388. DOI: https://doi.org/10.21037/tau.2019.07.09
Satyagraha P, Alluza HHD, Daryanto B, Nurhadi P. Prone vs Supine PCNL: What about the Cost?. J Med - Clin Res & Rev. 2018;2: 1-6. DOI: https://doi.org/10.33425/2639-944X.1067
Birowo P, Tendi W, Widyahening IS, et al. Supine versus prone position in percutaneous nephrolithotomy: a systematic review and meta-analysis. F1000Res. 2020; 9:231. DOI: https://doi.org/10.12688/f1000research.22940.3
Li J, Gao L, Li Q, et al. Supine versus prone position for percutaneous nephrolithotripsy: A meta-analysis of randomized controlled trials. Int J Surg. 2019; 66:62-71. DOI: https://doi.org/10.1016/j.ijsu.2019.04.016
Türk C, Petrík A, Sarica K, et al. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2016; 69:475-82. DOI: https://doi.org/10.1016/j.eururo.2015.07.041
Sharma GR, Maheshwari PN, Sharma AG, et al. Fluoroscopy guided percutaneous renal access in prone position. World journal of clinical cases 2015; 3: 245-264. DOI: https://doi.org/10.12998/wjcc.v3.i3.245

How to Cite

Ananda, I. G. Y. P., Santosa, K. B., Yudiana, I. W., Tirtayasa, P. M. W., Pramana, I. B. P., Prayudi, N. G., & Duarsa, G. W. K. (2024). Barts flank-free modified supine position vs prone position in percutaneous nephrolithotomy: Systematic review and meta analysis. Archivio Italiano Di Urologia E Andrologia. https://doi.org/10.4081/aiua.2024.12944
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