Percutaneous Nephrolithotomy (PCNL): The Supine Approach – Overcoming the Difficulties

Percutaneous nephrolithotomy (PCNL) is today accepted as the first-choice technique when managing complex renal stones. When taking into consideration the retroperitoneal position of the kidney, its relationship with other organs, and its own particular vascular distribution, the safest access to the urinary tract appears to be through a posterior calyx papilla, and the approach will always be through the lumbar area of the patient. Therefore, traditionally, the patient has been placed in the prone position. Nevertheless, other decubitus positions have been used for patients (supine, Valdivia-Galdakao, and intermediate supine).