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Post-Operative Complications of the Exaggerated Lithotomy Position
Mary H James, Paul D. McAdams, Britton E. Tisdale, Gerald H. Jordan, Kurt A. McCammon
Eastern Virginia Medical School, Norfolk, VA

Introduction:
The exaggerated lithotomy position provides excellent exposure to the perineum during urethral surgery. Recent studies have reported a high complication rate for this position suggesting that its use should be limited. We present 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. Positioning related complications and time in exaggerated lithotomy position were collected.
Results:
All patients except one underwent urethral reconstruction. Average time in the exaggerated lithotomy position was 172 minutes (105-230 minutes). Twenty three patients (21.9%) had complications felt to be positioning related, the majority of which resolved without additional treatment or sequelae. The most common findings were paresthesias of the lower extremity seen in 20 patients (19.0%) and musculoskeletal back pain in 4 patients (3.8%). 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 continued to improve at time of discharge and did not warrant further intervention. A single patient (0.9%) had a pulmonary embolus. Medical work-up revealed the presence of lupus anticoagulants, an additional risk factor for 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.


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