Simultaneous antegrade/retrograde upper urinary tract access: Bart's modified lateral position for complex upper
Konstantinos Moraitis1, Prodromos Philippou, Tamer El-Husseiny
1Endourology and Stone Services, Department of Urology, St. Bartholomew's Hospital and The London National Health Service Trust, London, United Kingdom. konstantinos.moraitis@bartsandthelondon.nhs.uk
Urology
|October 18, 2011
Summary
The modified lateral position is a safe and effective technique for simultaneous anterograde and retrograde access in complex urinary tract conditions, offering wide exposure and enhanced control for surgeons.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Endourology
Background:
- Complex upper urinary tract pathologies often require advanced surgical approaches.
- Simultaneous anterograde and retrograde access can be challenging in these cases.
Purpose of the Study:
- To evaluate the safety and efficacy of the Bart's modified lateral position for simultaneous anterograde and retrograde access.
- To assess its utility in treating complex upper urinary tract conditions.
Main Methods:
- 45 procedures were performed using the modified lateral position with simultaneous anterograde and retrograde access.
- Patients had complex unilateral upper urinary tract pathologies and were under general anesthesia.
- Exclusion criteria included muscular and/or skeletal abnormalities.
Main Results:
- 80% stone clearance was achieved in a single procedure.
- Successful recanalization was observed in all patients with pelviureteral junction obstruction and ureteral strictures.
- Minor complications included persistent hematuria (8.8%) and urinary sepsis (4.4%).
Conclusions:
- The modified lateral position is comparable to standard percutaneous nephrolithotomy techniques.
- It offers excellent flank exposure, multiple access options, and enhanced instrument control.
- This position facilitates simultaneous work by two surgeons for complex endourologic procedures in high-risk patients.
Related Concept Videos
01:22Imaging Studies V: Intravenous Urography and Retrograde Pyelography
IntroductionIntravenous Urography (IVU) and Retrograde Pyelography (RP) are important diagnostic imaging techniques used to evaluate the urinary system. These methods help identify structural abnormalities, obstructions, and functional issues in the kidneys, ureters, and bladder. Both procedures use iodine-based contrast media to enhance the visibility of urinary tract structures on X-ray images, though they differ in their methods and indications.1. Intravenous Urography (IVU)Intravenous...
01:11Anatomy of the Genitourinary System I: Kidneys and Ureters
The upper urinary system comprises two kidneys and two ureters, which are crucial in filtering blood and forming urine.KidneysLocation and Structure:The kidneys are two bean-shaped organs positioned behind the peritoneum on either side of the spine.Kidneys are between the 12th thoracic (T12) and the 3rd lumbar (L3) vertebrae.The position of the liver causes the right kidney to sit slightly lower than the left.Protective Layers:Each kidney is enveloped in a tough, fibrous membrane called the...
01:25Urinary Tract Calculi VI: Surgical Management
Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
01:22Ureters
The ureters are retroperitoneal tubes located on either side of the vertebral column. They are responsible for transporting urine from each kidney to the urinary bladder. These tubes have thick walls and are approximately 25-30 cm long. Their diameter is around 10 mm at the renal pelvis, gradually narrowing to 1 mm as the ureter obliquely enters the posterior bladder wall through the ureteric orifices. The shape of these orifices is slit-like, which helps to prevent urine backflow toward the...
01:28Urologic Endoscopic Procedure: Cystoscopic Examination
Meaning of Cystoscopic Examination:Cystoscopy is an essential diagnostic tool in urology that is used to assess the structure and function of the genitourinary system. It provides a direct view of the urethra, bladder, and, in some cases, the ureteral openings. This procedure helps detect structural abnormalities, infections, cancers, and blockages in the urinary tract. There are two types of cystoscopy:Flexible cystoscopy is commonly performed in outpatient settings due to its less invasive...