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

Authors

I Gede Yogi Prema Ananda
yogiprema16@gmail.com
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
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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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 <i>vs.</i> prone position in percutaneous nephrolithotomy: Systematic review and meta analysis. Archivio Italiano Di Urologia E Andrologia, 96(4). https://doi.org/10.4081/aiua.2024.12944
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