Recently, the global endourology scene has witnessed a resurgence of interest in supine PCNL (sPCNL). The number of urologists who are attracted to this “simplified method” of PCNL is growing and its promoters are suggesting to abandon the standard prone approach. Debates on the two positions have become commonplace in endourology scientific meetings. The advocates consistently emphasize that when compared to the prone position, sPCNL has multiple advantages for the surgeon, the anesthesia team and the patient. In spite of these, it is evident that many still favor prone PCNL (pPCNL) because of its time-tested proven efficacy and safety. In fact, up to this present day, majority of PCNLs are still done in the prone position. This review article intends to analyze the “current state of affairs” of the two PCNL positions, describing their advantages and disadvantages. Presently, applying the principles of “what is safe and efficacious in one’s hands” dictates the choice of which technique is utilized to treat a patient. Conversely, it is more clinically sound if this choice was made instead, in consideration of, the interplay of the following factors such as the patient’s clinical demographics, the anatomical features of the renal collecting system, the stone burden and characteristics and ultimately, the physician’s training, skills and experience.
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