Reverse Trendelenburg Positioning Minimizes Stone Retropulsion During Ureteroscopic Laser Lithotripsy: A Prospective
Harry Anastos1, Alan J Yaghoubian1, Johnathan A Khusid1
1Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Journal of Endourology
|April 13, 2023
Summary
Reverse Trendelenburg positioning significantly reduces ureteral stone fragment retropulsion during ureteroscopic laser lithotripsy (URSLL). This improved technique also decreases operative time and the need for ureteroscope conversion, enhancing patient outcomes.
Area of Science:
- Urology
- Surgical Innovation
- Minimally Invasive Procedures
Background:
- Retropulsion of stone fragments during ureteroscopic laser lithotripsy (URSLL) is a significant challenge.
- This phenomenon increases operative time and reduces the stone-free rate (SFR).
Purpose of the Study:
- To compare the rate of ureteral stone fragment retropulsion during URSLL.
- To evaluate the efficacy of standard dorsal lithotomy (SDL) position versus dorsal lithotomy with reverse Trendelenburg (RT) position.
Main Methods:
- 114 patients with ureteral stones were randomized into two groups: SDL and RT.
- Primary outcome: stone retropulsion. Secondary outcomes: retropulsion to kidney, SFR, operative time, complications, and ureteroscope conversion.
- Statistical analysis included chi-square, Fisher exact, Kruskal-Wallis, and t-tests.
Main Results:
- Retropulsion was significantly less frequent in the RT group (10.5%) compared to SDL (68.4%).
- The RT group showed a lower risk of retropulsion into the kidney (5.3% vs 40.4%), reduced operative time (33.0 vs 43.5 minutes), and fewer ureteroscope conversions (2.2% vs 16.7%).
- No significant difference in stone-free rate (95% vs 100%) was observed.
Conclusions:
- Reverse Trendelenburg positioning during URSLL for ureteral stones significantly decreases stone retropulsion.
- This positioning also reduces operative time and the need for ureteroscope conversion.
- RT position offers a promising strategy to improve URSLL outcomes.
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