PD26-08 IMPACT OF REVERSE TRENDELENBURG POSITION ON URETERAL STONE RETROPULSION: A PROSPECTIVE RANDOMIZED STUDY

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy III (PD26)1 Sep 2021PD26-08 IMPACT OF REVERSE TRENDELENBURG POSITION ON URETERAL STONE RETROPULSION: A PROSPECTIVE RANDOMIZED STUDY Johnathan Khusid, Harry Anastos, Ryan Chandhoke, Dara Lundon, Areeba Sadiq, Jake Bamberger, Blair Gallante, William Atallah, and Mantu Gupta Johnathan KhusidJohnathan Khusid More articles by this author , Harry AnastosHarry Anastos More articles by this author , Ryan ChandhokeRyan Chandhoke More articles by this author , Dara LundonDara Lundon More articles by this author , Areeba SadiqAreeba Sadiq More articles by this author , Jake BambergerJake Bamberger More articles by this author , Blair GallanteBlair Gallante More articles by this author , William AtallahWilliam Atallah More articles by this author , and Mantu GuptaMantu Gupta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002019.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Minimizing retropulsion may improve surgical efficiency during ureteroscopic lithotripsy. This study seeks to determine if reverse Trendelenburg (RT) positioning during ureteroscopic lithotripsy effects rates of stone retropulsion in patients with ureteral stones. METHODS: We prospectively recruited adult patients with radiographic evidence of a single ureteral stone and plans to undergo ureteroscopic lithotripsy. Patients were randomized to one of two positioning cohorts: standard supine dorsal lithotomy or dorsal lithotomy with RT position. In all cases in which retropulsion occurred, flexible ureteroscopy/pyeloscopy was performed to retrieve residual stone fragments. The primary endpoint of the study was any amount of stone retropulsion. Secondary endpoints were stone retropulsion into the kidney, stone free status, and post-operative hydronephrosis. RESULTS: To date, 91 patients have completed the study; 44 in the standard positioning group and 47 in the RT group. There were no significant differences between groups in age, gender, ASA score, BMI, stone location and stone composition at the time of ureteroscopy. In the RT group, retropulsion occurred significantly less often (9.0% of cases vs 63.8% of cases; odds ratio (OR) 0.06, p<0.001). Similarly, in the RT group, retropulsion to the kidney occurred less often (6.8% of cases vs 34% of cases; OR 0.15, p=0.001). Among the patients with adequate follow up imaging to assess for stone free status (74 patients) and hydronephrosis (65 patients), there were no significant differences between groups in the stone free status (94.9% of cases vs 88.6% of cases; p=0.364), or post-operative hydronephrosis (2.1% of cases vs 0% of cases; p=1.000). CONCLUSIONS: Reverse Trendelenburg positioning during ureteroscopic lithotripsy decreases both retropulsion in general, and retropulsion into the kidney. There was no significant impact on stone free status or post-operative hydronephrosis, which was likely secondary to our routine use of flexible ureteroscopy/pyeloscopy to retrieve any retropulsed fragments. The use of the RT position has the potential to decrease operative time, decrease the need for use of extra equipment, and potentially improve stone free rates in practice setting in which flexible ureteroscopes are not routinely available. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e440-e440 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Johnathan Khusid More articles by this author Harry Anastos More articles by this author Ryan Chandhoke More articles by this author Dara Lundon More articles by this author Areeba Sadiq More articles by this author Jake Bamberger More articles by this author Blair Gallante More articles by this author William Atallah More articles by this author Mantu Gupta More articles by this author Expand All Advertisement Loading ...