You are here: Urology Textbook > Index > Lithotomy position
Lithotomy Position in Urology: Indications and Contraindications
The lithotomy position of the patient 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 flexion of the lumbar spine, 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 must be mounted in special holders.
Complications of the Lithotomy Position
Very rare: compartment syndrome of the leg, nerve injury by pressure (femoral nerve 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)
- Surgery of the female urethra: tension-free vaginal tape, treatment of urethral caruncle
- Surgery of the male urethra: internal urethrotomy
- Perineal prostatectomy
Contraindications for a Lithotomy Position
Contractures or hip joint diseases may prevent a lithotomy position, particularly if flexion or abduction of the hip joint is not possible.
Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
Deutsche Version: Steinschnittlage