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AbstractIntroduction:The prone position has been considered the only position for percutaneous access to the kidney for the past 25 years, whereas the supine Valdivia position has recently started to gain acceptance, although it was originally described in the late 1980s. Even more recently, the Galdakao-modified supine Valdivia position was described. However, there is no consensus on which is the best position for percutaneous nephrolithotomy, and the choice is currently based on the surgeon's preference.Materials and Methods:The prone, supine, and modified supine positions are described, pointing out the advantages, disadvantages, and results of each technique.Results:A number of potential advantages have been described for the supine over the prone position: less cardiovascular change; no need for patient repositioning (with less associated risk of central and peripheral nervous system injury); less X-ray exposure to the surgeon; and less risk of colonic injury. The recently described Galdakao-modified supine Valdivia position allows for a simultaneous anterograde and retrograde approach to the renal cavities for the one-stage treatment of complex renal stones or concurrent renal and ureteral calculi. Moreover, the use of a flexible ureteroscope allows for Endovision puncture to achieve perfect access to the kidney.Conclusions:The prone position still represents the standard for percutaneous access to the kidney, and other positions should be compared with this position. However, the supine and the modified supine positions have potentially important advantages for both patients and surgeons that need to be investigated in a large randomised trial to define their superiority over the traditional prone position. [ABSTRACT FROM AUTHOR]

AbstractPurpose:To compare the transperitoneal approach and the retroperitoneal approach in the laparoscopic management of ureteral stones, at two different urologic centers during the learning curve period.Materials and Methods:We prospectively evaluated 35 consecutive laparoscopic ureterolithotomies performed by two different urologists during their learning curve period in laparoscopy. Each surgeon used a different approach: Transperitoneal (group A) and retroperitoneal (group B). Timing for patients' positioning, trocar placement, ureter isolation, stone extraction, and suturing were recorded to compare the transperitoneal with the retroperitoneal method. Intraoperative complications and perioperative morbidity were also reported.Results:Eighteen procedures were performed using the transperitoneal method (group A) and 17 using the retroperitoneal method (group B). Significant differences between group A and B were observed in terms of time for access to the operating field (mean times 14 and 24 min, respectively, P= < 0.001); time for suturing the ureter (mean times 16 and 28 min, respectively, P= < 0.001); and total operative time (mean times 75 and 102 min, respectively, P= 0.002). No statistical differences were observed for any other parameters. Blood loss was minimal in all cases (mean losses 50 and 45 mL, respectively, P= 0.852); and hemotransfusion was not needed by either group. At the 12-month follow-up, no cases of ureteral stricture were recorded.Conclusions:We suggest that urologists in training for laparoscopy perform laparoscopic ureterolithotomy using a transperitoneal route. In expert hands, both transperitoneal and retroperitoneal approaches are feasible, and the choice depends on personal preference. [ABSTRACT FROM AUTHOR]