INTRODUCTION
Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure used for removing kidney stones, where the patient's positioning can significantly impact the rate of stone clearance [1]. Specifically, research has compared the prone (lying face down) and supine (lying face up) positions to determine which is more effective for facilitating stone clearance [2]. Understanding the comparative efficacy of these positions is crucial for optimizing patient outcomes in PCNL procedures.
OBJECTIVE
To compare the rate of stone clearance in prone versus supine position in percutaneous nephrolithotomy in tertiary care hospital.

STUDY DESIGN
Descriptive Case Series Study.
SETTING
This study was conducted at the Department of Urology, JPMC, Karachi, Pakistan.
DURATION
Six months after the approval of the synopsis from January 9, 2023 to July 8, 2023.

MATERIALS AND METHODS
All eligible patients visiting Jinnah Postgraduate Medical Centre (JPMC), Karachi, were enrolled in the study after providing informed consent, which outlined the study's procedures, risks, and benefits. Preoperative assessments included measurements of hemoglobin, hematocrit, serum creatinine, and stone size. For the percutaneous nephrolithotomy, patients were randomly assigned to either Group A, which utilized the prone position, or Group B, employing the supine position. Stone clearance was evaluated during a 4-week follow-up period. Data were systematically collected and recorded using an electronic proforma designed for research analysis.

In this study, Group A (prone) had a median age of 30 years, while Group B (supine) had a median age of 35 years. Compositionally, Group A consisted of 49 males and 31 females, representing 61.3% and 38.7% of the group, respectively. In contrast, Group B comprised 43 males and 37 females, accounting for 53.8% and 46.2% of the group, respectively. In terms of treatment outcomes, stone clearance was achieved in 38 (47.5%) patients in Group A and 63 (78.8%) patients in Group B, with the difference being statistically significant (p=0.0001).

PCNL patients were divided into 2 groups, one group was operated in supine and another group was operated in prone and the rate o stone clearance was calculated.

It is to be concluded that a highly significant difference in stone clearance rates was observed between the prone and supine positions during percutaneous nephrolithotomy. The supine position has superior stone clearance rates, with significant implications for surgical planning and patient management. Further research is recommended to validate these results and incorporate them into clinical practice recommendations to improve percutaneous nephrolithotomy patient care.

Desoky EAE, Allam MN, Ammar MK, Abdelwahab KM, Elsaid DA, Fawzi AM, et al. Flank free modified supine position: a new modification for supine percutaneous nephrolithotomy. Arab J Urol.2012;10(2):14-38.
Nour HH, Kamal AM, Ghobashi SE, Zayed AS, Rushdy MM, El-Baz AG, et al. Percutaneous nephrolithotomy in the supine position: Safety and outcomes in a single centre experience. Arab J Urol.2013;11(1):627.
Mazzucchi E, Vicentini FC, Marchini GS, Danilovic A, Brito AH, Srougi M. Percutaneous nephrolithotomy in obese patients: comparison between the prone and total supine position. J Endourol 2012;26(11):1437-42.