ArticleUrolithiasis2026
Learning curves after position switch in PCNL: prone- vs. supine-trained surgeons.
Article in Urolithiasis, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Percutaneous nephrolithotomy (PCNL) can be performed in both prone and supine positions, each with distinct ergonomic and anatomical advantages. However, data on how urologists adapt when transitioning between these techniques remain limited. This study aimed to evaluate and compare the learning curves of urologists switching from prone to supine PCNL and vice versa. A total of 120 consecutive PCNL procedures performed between December 2023 and September 2025 were retrospectively analyzed. Each surgeon completed 60 cases after adopting the alternate position (prone→supine and supine→prone). Cases were divided into chronological quartiles (1–15, 16–30, 31–45, 46–60) to assess operative time, access time, fluoroscopy duration, stone-free rate (SFR), complication rates, and hospitalization length. Baseline demographics and stone characteristics were comparable between groups. Operative efficiency improved progressively with experience in both cohorts, with operative time decreasing from 98.2 to 80.6 min in the prone PCNL group and from 83.7 to 64.3 min in the supine PCNL group. Fluoroscopy exposure and access time showed parallel reductions (median fluoroscopy time: 81→62 s and 51→26 s, respectively). The SFR improved from 53.3% to 80.0% in the prone group and from 46.7% to 86.7% in the supine group. Overall and major (Clavien–Dindo III–V) complication rates remained low and stable throughout the learning period. Multivariable logistic regression revealed that increasing experience independently correlated with success in the supine cohort, while stone size, BMI, and fluoroscopy time were not independent predictors in either group. These findings indicate that both surgeons achieved significant improvements in efficiency and outcomes after switching positions, with supine PCNL demonstrating a steeper yet shorter learning curve. Prior experience in prone PCNL may facilitate adaptation to the supine approach, highlighting the value of structured training and mentorship in optimizing procedural proficiency and patient safety.
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