Hemodynamic Effects of Surgical Position in Prone vs. Supine Percutaneous Nephrolithotomy

Condition(s) studied

Investigational drug(s) / intervention(s)

Prone Position Percutaneous Nephrolithotomy: Patients in this arm will undergo percutaneous nephrolithotomy (PNL) in the prone position. The procedure begins with ureteral catheter placement in lithotomy position, followed by prone positioning for renal access under C-arm fluoroscopic guidance. Stone fragmentation will be performed using pneumatic or ultrasonic lithotripters, and nephrostomy placement will be completed according to standard protocol.

Supine Position Percutaneous Nephrolithotomy (Galdakao-modified Valdivia): Patients in this arm will undergo percutaneous nephrolithotomy (PNL) in the Galdakao-modified Valdivia supine position. Following general anesthesia, the ipsilateral side will be elevated 20-30°, with the ipsilateral leg extended and the contralateral leg abducted. Ureteral catheter placement will be followed by renal access under C-arm fluoroscopy. Stone fragmentation and removal will be performed using the same standardized lithotripsy and irrigation protocols as in the prone group.

Study summary

This prospective, randomized controlled study evaluates the hemodynamic effects of prone and supine positions during percutaneous nephrolithotomy (PNL) for large kidney stones. Surgical position may influence intraoperative and postoperative hemodynamic stability. Prone positioning can increase intrathoracic pressure and reduce venous return, whereas supine positioning may provide greater hemodynamic stability. A total of 84 patients will be randomized to undergo PNL in prone or supine positions. Primary outcomes include changes in hemodynamic parameters during surgery. Results may guide surgical position selection, especially in patients with potential hemodynamic risk.

Eligibility

Primary outcome measure(s)

• Change in Hemodynamic Parameters (Intraoperative) — From induction of anesthesia to the end of surgery (approximately 60-120 minutes)
  Systolic blood pressure (mmHg) will be recorded at predefined time points (preoperative baseline, intraoperative intervals, and immediate postoperative period) to assess intraoperative hemodynamic stability.
• Change in Arterial Blood pH — Preoperative, intraoperative, postoperative day 1
  Arterial pH will be measured at predefined time points (preoperative, intraoperative, postoperative day 1) to evaluate metabolic changes between prone and supine groups.
• Change in Diastolic Blood Pressure (Intraoperative) — From induction of anesthesia to the end of surgery (approximately 60-120 minutes
  Diastolic blood pressure (mmHg) will be recorded at predefined time points (preoperative baseline, intraoperative intervals, and immediate postoperative period) to assess intraoperative hemodynamic stability.
• Change in Mean Arterial Pressure (Intraoperative) — From induction of anesthesia to the end of surgery (approximately 60-120 minutes)
  Mean arterial pressure (mmHg) will be recorded at predefined time points (preoperative baseline, intraoperative intervals, and immediate postoperative period) to assess intraoperative hemodynamic stability.
• Change in Heart Rate (Intraoperative) — From induction of anesthesia to the end of surgery (approximately 60-120 minutes)
  Heart rate (beats per minute) will be recorded at predefined time points (preoperative baseline, intraoperative intervals, and immediate postoperative period) to assess intraoperative hemodynamic stability.
• Change in Arterial pO₂ — Preoperative, intraoperative, postoperative day 1
  Arterial oxygen partial pressure (mmHg) will be measured at predefined time points (preoperative, intraoperative, postoperative day 1) to evaluate respiratory function.
• Change in Arterial HCO₃- — Preoperative, intraoperative, postoperative day 1
  Arterial bicarbonate (mmol/L) will be measured at predefined time points (preoperative, intraoperative, postoperative day 1) to evaluate metabolic changes.
• Change in Oxygen Saturation — Preoperative, intraoperative, postoperative day 1
  Arterial oxygen saturation (%) will be measured at predefined time points (preoperative, intraoperative, postoperative day 1) to evaluate respiratory status.
• Change in Arterial pCO₂ — Preoperative, intraoperative, postoperative day 1
  Arterial carbon dioxide partial pressure (mmHg) will be measured at predefined time points (preoperative, intraoperative, postoperative day 1) to evaluate respiratory changes.

Trial sites (1)

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