Supine Percutaneous Nephrolithotomy: A Retrospective Analysis of Surgical Outcomes, Safety, and Efficiency in a High-Risk Population

Introduction Supine percutaneous nephrolithotomy (PCNL) offers ergonomic and anaesthetic advantages over the conventional prone approach, particularly in patients with obesity or cardiopulmonary comorbidities. Despite supporting evidence, adoption remains limited due to perceived technical challenges. This study evaluates the surgical outcomes, safety, and efficiency of supine PCNL. Materials and Methods A retrospective observational study was conducted on 120 adults undergoing supine PCNL between January 2023 and January 2024 at a tertiary care centre. Patients were positioned in the Galdakao-modified supine Valdivia position. Primary outcomes included operative and anaesthesia times, stone clearance rate, complications (Clavien–Dindo classification), and hospital stay. Secondary outcomes were perioperative haemoglobin change and transfusion requirements. Results Mean patient age was > 40 years. Stones > 1500 mm³ occurred in 54.2%. Complete stone clearance was achieved in 95% of patients. Mean operative time was 64.04 ± 16.63 min, and mean anaesthesia time was 81 ± 18.63 min. Mean haemoglobin drop was 0.579 g/dL. Complication rate was 5.7%, predominantly Clavien–Dindo Grade I–II; no organ injuries occurred. Blood transfusions were required in 4.2% ( p  = 0.04). Most patients (96.7%) were discharged on postoperative day 2 . Conclusion Supine PCNL achieves high stone clearance rates, shorter operative and anaesthesia times, and low complication rates (p < 0.001 for haemoglobin drop), even in obese and comorbid patients. These findings support its broader adoption as a safe, efficient alternative to prone PCNL in nephrolithiasis management.