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Lithotomy Position in Urology: Indications and Contraindications

The lithotomy position is needed for examinations or operations in urology, gynecology, or proctology. The lithotomy position is also a common position for childbirth. The term lithotomy refers to the historical techniques of bladder stone therapy, as in the former ages, perineal approaches to the stone were common (sectio lateralis and sectio mediana).

The Technique of the Lithotomy Position

The patient lies on his back, and the legs are flexed in the hip (90 degrees) and abducted (30 degrees) in the hip. The knees are bent 70 to 90 degrees; the lower legs are supported on padded leg shells.

Surgery of the membranous urethra or perineal approach to the prostate requires an extreme lithotomy position. With additional lumbar spine flexion, lifting of the buttocks (oblique positioning cushion), and increased hip joint flexion, the perineum can be aligned parallel to the floor. The padding of all the relevant pressure points is of paramount importance. The legs are mounted in special holders.

Complications of the Lithotomy Position

Uncommon is compartment syndrome of the leg or nerve injury by pressure (femoral or peroneal nerve). Risk factors include a long time of the lithotomy position and a strong flexion and rotation of the hip joint.

Indications: Common Procedures in Urology with Lithotomy Position

• Pelvic examination
• Prostate examination
• Transurethral resection of the bladder (TURB)
• Transurethral resection of the prostate (TURP)
• Ureteroscopy
• Surgery of the female urethra: tension-free vaginal tape, treatment of urethral caruncle
• Surgery of the male urethra: internal urethrotomy, urethroplasty, urethrectomy.
• Perineal prostatectomy

Contraindications for a Lithotomy Position

Contractures or hip joint diseases may prevent a lithotomy position, mainly if flexion or abduction of the hip joint is impossible.

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