Reverse lithotomy: modified prone position for simultaneous nephroscopic and ureteroscopic procedures in women

Occasionally there is need for nephroscopic and ureteroscopic access during the same surgical procedure. Patient positioning is problematic and usually the patient must be turned from supine to prone position or vice versa. Simultaneous access is possible by placing the patient in a prone position with the thighs and knees cradled laterally in a "boot" type stirrup. Thus access is afforded to a percutaneous nephrostomy tract and to the urethra for nephroscopic and ureteroscopic procedures, and at the same time adequate operator comfort is maintained. This approach has been used four times in 3 patients and has been a valuable factor in the endoscopic removal of massive renal and ureteral calculi.