Prone CT Is Associated With Improved Safety and Stone-Free Outcomes in Prone PCNL: A Propensity-Matched Comparative Study

Purpose: To evaluate whether prone-position computed tomography (CT) is associated with improved perioperative outcomes in patients undergoing prone percutaneous nephrolithotomy (PCNL) compared with conventional supine CT. Patients and Methods: This single-center retrospective study included patients who underwent prone PCNL between June 2021 and January 2024. Patients were grouped according to preoperative CT position. CT position was not randomized. Propensity score matching (1:1) was performed using age, sex, side, body mass index, maximal stone diameter, stone density, and degree of hydronephrosis, yielding 62 matched pairs. Operative time, number of percutaneous tracts, primary stone-free rate (SFR), and perioperative complications were compared between groups. Results: After matching, baseline characteristics were comparable between the groups. Compared with supine CT, prone CT was associated with a shorter operative time (79.55 ± 14.32 vs 86.74 ± 13.27 minutes; P = 0.004), fewer percutaneous tracts (1.10 ± 0.30 vs 1.27 ± 0.52; P = 0.021), and a higher primary SFR (83.9% vs 67.7%; P = 0.036). The overall complication rate was lower in the prone CT group (3/62 vs 10/62; P = 0.040), and no pleural injuries occurred in this group. On multivariable analysis, prone CT remained associated with a higher primary SFR (odds ratio [OR]: 2.63, 95% confidence interval [CI]: 1.05–6.61; P = 0.039) and fewer perioperative complications (OR: 0.22, 95% CI: 0.05–0.96; P = 0.044). Conclusions: Prone CT may improve tract planning and early outcomes in selected patients undergoing prone PCNL, but these findings remain hypothesis-generating.