Prone Position: A Better Option for Treating Proximal Ureteral Stones with Shock Wave Lithotripsy

A new study published in the World Journal of Urology has revealed that the prone position is more effective than the supine position for treating proximal ureteral stones using ultrasound-guided shock wave lithotripsy (SWL). This multi-center research, conducted between June 2020 and December 2023, highlights the importance of patient positioning in improving treatment outcomes.

Key Findings from the Study

The study involved 1,187 patients with proximal ureteral stones, nearly evenly divided between treatment in the prone (50.5%) and supine (49.5%) positions. Researchers compared their outcomes using a variety of metrics, including:

  • Stone-Free Rate (SFR):
    • Prone position: 85.7%
    • Supine position: 77.4%
    • Conclusion: The prone position had significantly better SFR results (P = 0.001).
  • Complete SFR (total elimination of stones):
    • Prone position: 83.3%
    • Supine position: 75.0%
  • Number of SWL Sessions:
    • Both groups required a similar number of sessions (prone: 1.27, supine: 1.20; P = 0.092).
  • Complication Rates:
    • No significant differences in complication rates were found between the two positions, confirming that the prone position is safe.

Why Does the Prone Position Work Better?

The prone position was associated with a shorter skin-to-stone distance (SSD), an essential factor for the success of SWL. Patients in the prone group had an SSD of 50 mm, compared to 101 mm in the supine group (P < 0.001). The shorter SSD in the prone position likely contributes to the higher success rates in eliminating stones.

Implications for Treatment

This study concludes that the prone position provides:

  • Higher success rates for breaking and removing proximal ureteral stones.
  • Similar safety levels compared to the supine position.
  • A strong case for prioritizing the prone position for eligible patients undergoing SWL.

Practical Takeaways for Doctors

  • Position Matters: Whenever feasible, consider using the prone position for patients with proximal ureteral stones undergoing SWL.
  • Tailored Treatments: These findings provide a basis for improving treatment protocols and tailoring care to maximize outcomes.

If you are a healthcare professional managing patients with proximal ureteral stones, consider discussing the benefits of the prone position for shock wave lithotripsy (SWL). Share this knowledge with your team and patients to improve treatment success rates and overall care.

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