Complications related to the high lithotomy position during urethral reconstruction

John G. Anema, Allen F. Morey, Jack W. Mcaninch, Layla A. Mario, Hunter Wessells

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Purpose: We identified risk factors for complications of the lower extremities related to high lithotomy positioning during specific urethral reconstruction procedures in male patients. Materials and Methods: Records from 185 open urethroplasties were evaluated for position related complications of the lower extremities (the compartmental syndrome, rhabdomyolysis, neurapraxia). Morphometric data (patient height, weight) and surgical details (duration of surgery and lithotomy positioning, types of repair and stirrups, stricture length and location) were assessed. Results: In the 185 patients 18 position related complications (10%) were identified, 4 of which were severe. Univariate analysis showed length of stricture, and duration of surgery and lithotomy positioning to be statistically significant risk factors (p <0.05). Height, weight, body mass index and type of stirrups did not increase risk. Anterior end-to-end anastomosis and straightforward buccal mucosa patch grafts entailed negligible risk. Longer procedures (prostatomembranous and penile skin flap repairs) had higher complication rates (12% and 22%, respectively). Beginning penile skin flap procedures with patients in the supine position during flap harvesting followed by repositioning into high lithotomy for perineal flap transfer virtually eliminated the risk of severe complications. Conclusions: The risk of position related complications during urethral reconstruction is directly proportional to the duration of high lithotomy positioning. Procedures of less than 5 hours in duration had minimal risk. For complex flap procedures, we perform penile flap dissection with the patient supine and reposition for perineal flap transfer.

Original languageEnglish (US)
Pages (from-to)360-363
Number of pages4
JournalJournal of Urology
Volume164
Issue number2
StatePublished - Aug 2000

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Lower Extremity
Pathologic Constriction
Weights and Measures
Skin
Rhabdomyolysis
Supine Position
Mouth Mucosa
Dissection
Body Mass Index
Transplants

Keywords

  • Compartment syndromes
  • Surgical flaps
  • Urethral obstruction

ASJC Scopus subject areas

  • Urology

Cite this

Anema, J. G., Morey, A. F., Mcaninch, J. W., Mario, L. A., & Wessells, H. (2000). Complications related to the high lithotomy position during urethral reconstruction. Journal of Urology, 164(2), 360-363.

Complications related to the high lithotomy position during urethral reconstruction. / Anema, John G.; Morey, Allen F.; Mcaninch, Jack W.; Mario, Layla A.; Wessells, Hunter.

In: Journal of Urology, Vol. 164, No. 2, 08.2000, p. 360-363.

Research output: Contribution to journalArticle

Anema, JG, Morey, AF, Mcaninch, JW, Mario, LA & Wessells, H 2000, 'Complications related to the high lithotomy position during urethral reconstruction', Journal of Urology, vol. 164, no. 2, pp. 360-363.
Anema, John G. ; Morey, Allen F. ; Mcaninch, Jack W. ; Mario, Layla A. ; Wessells, Hunter. / Complications related to the high lithotomy position during urethral reconstruction. In: Journal of Urology. 2000 ; Vol. 164, No. 2. pp. 360-363.
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