Background: The best way in the management of calyceal stone by percutaneous nephrolithotomy (PCNL) is to go
directly into the desired calyx. However, in upper calyx, this direct entry may be associated with undesired complications,
and through lower calyx is limited in prone PCNL. Recently, there is another option about reaching it through
the lower calyx in supine position with more accessibility and better manipulation. This study aimed to evaluate the
management of the upper calyceal stone by PCNL through lower calyx access in prone versus supine position.
Methods: A total of 38 patients with upper calyceal stone (≥ 2 cm) were randomly divided into two groups; the first
group included 18 patients managed by PCNL in the prone position, and the second group included 20 patients
managed in supine position. All data of both procedures were collected and statistically analyzed to compare
between both groups.
Results: There is no statistically significant difference between groups as regards demographic and stone characters.
The angle between the access to the lower calyx and access of the upper calyx was significantly wider in the supine
group versus prone group (130.2° ± 23.46° vs. 89.67° ± 14.56°, respectively). The mean operative and fluoroscopy time
was significantly longer in the prone group. There is no significant difference in intraoperative or postoperative morbidity.
The stone-free rate was significantly higher in the supine group than the prone group (85% vs 38.9%, respectively).
Also stone approachability was higher in the supine group than prone group (95% vs. 66.7%, respectively).
Conclusion: Management of upper calyceal stone by PCNL through the lower calyx is safe, but it is more effective in
the supine position than in prone position.