Urologists encounter multiple challenges in managing ureteral stones with ureteroscopic laser lithotripsy. This meta-analysis assesses the effectiveness of alternative surgical positioning, Reverse Trendelenburg (RevTren) and Trendelenburg (Tren), in reducing stone migration and enhancing outcomes compared to standard dorsal lithotomy positioning.
A systematic review was conducted following PRISMA guidelines, searching Medline, Embase, Scopus, Cochrane, and WoS up to March 2024. The review focused on studies evaluating RevTren or Tren positioning during ureteroscopic lithotripsy compared to standard dorsal lithotomy, analyzing endpoints such as stone migration, conversion rates, success rates, complications, and operative time.
Out of 137 studies identified, 8 met the inclusion criteria, encompassing 1374 patients. RevTren significantly reduced ureteral stone migration (odds ratio [OR] 0.20, 95% confidence interval [CI] [0.08, 0.47]), lowered the need for conversion to a flexible ureteroscope (OR 0.28, 95% CI [0.12, 0.67]), and improved success rates (OR 2.90, 95% CI [1.88, 4.48]). Tren increased migration of ureteral and calyceal stones towards upper renal calyces (OR 2.12, 95% CI [1.48, 3.04]) and achieved a higher success rate (OR 3.56, 95% CI [2.15, 5.92]). Complications were comparable across all positions.
Adjusting patient positioning during ureteroscopic laser lithotripsy can enhance procedure outcomes. RevTren effectively reduces ureteral stone migration and the necessity for flexible ureteroscopes, while Tren facilitates ureteral and calyceal stone migration towards upper calyces, increasing success rates. Both positioning techniques offer significant advantages over standard positioning and can be safely adopted in clinical practice without compromising patient safety.
The Journal of urology. 2024 Sep 30 [Epub ahead of print]
Henrique L Lepine, Fabio C Vicentini, Wilson R Molina, Carolina M Llata, Giovanni S Marchini, Fabio C M Torricelli, Carlos A Batagello, Alexandre Danilovic, William C Nahas, Eduardo Mazzucchi
University of São Paulo School of Medicine, São Paulo, SP, Brazil., Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil., University of Kansas, Endourology Section.