You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery1 Apr 2011104 POST-OPERATIVE COMPLICATIONS OF THE EXAGGERATED LITHOTOMY POSITION Paul D. McAdams, Britt E. Tisdale, Mary F. Henderson, Gerald H. Jordan, and Kurt A. McCammon Paul D. McAdamsPaul D. McAdams Norfolk, VA More articles by this author , Britt E. TisdaleBritt E. Tisdale Norfolk, VA More articles by this author , Mary F. HendersonMary F. Henderson Norfolk, VA More articles by this author , Gerald H. JordanGerald H. Jordan Norfolk, VA More articles by this author , and Kurt A. McCammonKurt A. McCammon Norfolk, VA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.169AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Open surgery through a perineal incision is required to visualize the urethra and other structures of the perineum during complex surgical repairs. The exaggerated lithotomy position provides excellent access to the perineum for mobilization of the entire urethra and enables two surgeons to work side-by-side with relative freedom of movement around a small incision. Recent studies have reported a high complication rate for this position and suggested that its use should be limited. We present a review of our experience with the exaggerated lithotomy position. METHODS Data was retrospectively reviewed on 105 patients who underwent surgery in the exaggerated lithotomy position at a single institution. All patients underwent surgery on a Skytron Elite 6000 operating room table with legs positioned in Allen stirrups. Positioning related complications, time spent in exaggerated lithotomy position and other data were collected on this cohort of patients. RESULTS All patients except one underwent urethral reconstruction. Average age was 42.6 years (range, 14 to 77 years). Follow-up ranged from 1 to 22 months (with a median of 6 months.) Average time in the exaggerated lithotomy position was 172 minutes (range, 105–230 minutes). Twenty three patients (21.9%) had complications felt to be positioning related, the majority of which were minor and resolved without additional treatment or sequelae. The most common findings were peripheral neuritis manifesting as paresthesias or hypoesthesias in the dorsum of the foot or toes from compression of peroneal nerve branches seen in 20 patients (19.0%) and musculoskeletal low back pain in 4 patients (3.8%). Two patients (1.9%) had manifestations of both. All but 3 of these patients (87%) had spontaneous resolution of these symptoms prior to discharge. Average time to resolution was 2.3 days. The symptoms in the remaining 3 patients were nearly resolved by the time they met all other discharge criteria and did not warrant further hospital monitoring. A single patient (0.9%) had a significant complication – a pulmonary embolus. Medical work-up revealed the presence of lupus anticoagulants, an additional risk factor for development of thrombosis. No patients had neurapraxia, rhabdomyolysis or compartment syndrome. CONCLUSIONS The exaggerated lithotomy position provides unequaled access to the perineum for urethral reconstruction. With appropriate equipment and attention to proper positioning, there is a relatively low risk of even minor, self-limited complications and is therefore our position of choice. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e44 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Paul D. McAdams Norfolk, VA More articles by this author Britt E. Tisdale Norfolk, VA More articles by this author Mary F. Henderson Norfolk, VA More articles by this author Gerald H. Jordan Norfolk, VA More articles by this author Kurt A. McCammon Norfolk, VA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...