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19.10.2023 | Original Article

A new position utilizing the effect of gravity in proximal ureteral stones, ureteroscopic lithotripsy in the reverse Trendelenburg position: a prospective, randomized, comparative study

verfasst von: Ali Kaan Yildiz, Omer Gokhan Doluoglu, Turgay Kacan, Bugra Bilge Keseroglu, Berat Cem Ozgur, Tolga Karakan

Erschienen in: World Journal of Urology | Ausgabe 12/2023

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Abstract

Purpose

To evaluate the effect of the reverse Trendelenburg position in patients undergoing ureteroscopic lithotripsy for proximal ureteral stones.

Methods

The study included 167 patients who underwent ureteroscopic lithotripsy for proximal ureter stones between December 2020 and September 2022. The patients were randomly assigned to one of three groups: standard lithotomy (n:55), 10° reverse Trendelenburg (n:55), and 20° reverse Trendelenburg (n:57). Preoperative information, including age, sex, body mass index (BMI), previous shock wave lithotripsy (SWL), stone side, volume, and density, distance to the ureteropelvic junction (UPJ) of the stone, and hydronephrosis degree. Stone-free status was evaluated with computed tomography (CT) at 4 weeks postoperatively. The groups were compared in respect of stone migration, stone-free rate, use of flexible ureterorenoscope, operating time, postoperative length of stay in the hospital, and complications.

Results

No statistically significant difference was determined between the groups with respect to age, sex, BMI, previous SWL, stone side, volume and density, distance to the UPJ of the stone, and hydronephrosis degree (p > 0.05 for all). Statistically significant differences were determined between the groups with respect to stone migration (p = 0.001), stone-free rate (p < 0.001), use of flexible ureterorenoscope (p = 0.01), operating time (p < 0.001), hospital length of stay (p < 0.001), postoperative fever (p = 0.002), and total complications (p = 0.01).

Conclusion

A new patient position is presented in this study, which can be used in ureteroscopic lithotripsy performed for proximal ureteral stones. The reverse Trendelenburg position constitutes a surgical method that can be used safely and successfully in the treatment of proximal ureteral stones.

Trial registration number

NCT04894058, 05/21/2021, Prospectively registered.

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Titel: A new position utilizing the effect of gravity in proximal ureteral stones, ureteroscopic lithotripsy in the reverse Trendelenburg position: a prospective, randomized, comparative study
verfasst von: Ali Kaan Yildiz
Omer Gokhan Doluoglu
Turgay Kacan
Bugra Bilge Keseroglu
Berat Cem Ozgur
Tolga Karakan
Publikationsdatum: 19.10.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 12/2023
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-023-04654-y

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A new position utilizing the effect of gravity in proximal ureteral stones, ureteroscopic lithotripsy in the reverse Trendelenburg position: a prospective, randomized, comparative study