COMPLICATIONS RELATED TO THE HIGH LITHOTOMY POSITION DURING URETHRAL RECONSTRUCTION

ANEMA, JOHN G.
MOREY, ALLEN F.
MCANINCH, JACK W.
MARIO, LAYLA A.
WESSELLS, HUNTER

From the Department of Urology, University of California School of Medicine, and San Francisco General Hospital, San Francisco, California, Urology Service, Brooke Army Medical Center, Fort Sam Houston, Texas, and Section of Urology, The University of Arizona, Tucson, Arizona

Accepted for publication March 17, 2000.

^* Requests for reprints: Urology Service 3A18, San Francisco General Hospital, 1001 Potrero Ave., San Francisco, California 94110.

Presented at annual meeting of American Urological Association, Dallas, Texas, May 1–6, 1999.

Journal of Urology 164(2):p 360-363, August 2000.

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.