Complications related to the high lithotomy position during urethral reconstruction

Purpose: We identified risk factors for complications of the lower extremit ies related to high lithotomy positioning during specific urethral reconstr uction procedures in male patients. Materials and Methods: Records from 185 open urethroplasties were evaluated for position related complications of the lower extremities (the compartme ntal syndrome, rhabdomyolysis, neurapraxia). Morphometric data (patient hei ght, weight) and surgical details (duration of surgery and lithotomy positi oning, types of repair and stirrups, stricture length and location) were as sessed. Results: In the 185 patients 18 position related complications (10%) were i dentified, 4 of which were severe. Univariate analysis showed length of str icture, and duration of surgery and lithotomy positioning to be statistical ly 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. Longe r procedures (prostatomembranous and penile skin flap repairs) had higher c omplication rates (12% and 22%, respectively). Beginning penile skin flap p rocedures with patients in the supine position during flap harvesting follo wed by repositioning into high lithotomy for perineal flap transfer virtual ly eliminated the risk of severe complications. Conclusions: The risk of position related complications during urethral rec onstruction is directly proportional to the duration of high lithotomy posi tioning. 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.