Supine versus prone pediatric percutaneous nephrolithotomy: A systematic review and meta-analysis

Percutaneous nephrolithotomy (PCNL) is the treatment of choice for pediatric nephrolithiasis more than 20 mm. Prone position was the preferred position for decades. Recently, supine position has gained more interest. This meta-analysis aims to evaluate the safety and efficacy of PCNL in supine versus prone position in pediatric population. A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library was performed till 28 February 2024. The study included comparative studies comparing both positions in children that were written in English. A total of three randomized studies and three retrospective studies were included with a total number of 290 patients. Cochrane risk-of-bias tool for randomized trials was used for quality assessment, while Newcastle-Ottawa scale was used for non-randomized controlled trials. The meta-analysis was conducted using Review Manager software. Numerical data were analyzed using standardized mean difference (SMD), while the risk ratio was used for analysis of categorical data. Fixed or random effects models were used according to heterogeneity. There were statistically insignificant differences between both groups for stone-free rate (RR 1.08, 95% CI [0.98-1.18], p = 0.11) and overall complications (RR 0.93, 95% CI [0.59-1.47], p = 0.76). Operation time was significantly shorter in supine group (SMD -0.99, 95% CI [-1.67 to -0.30], p = 0.005). Therefore, comparable efficacy and safety outcomes were proved between both supine and prone positions for PCNL in pediatrics.