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The lithotomy position of the patient is needed for examinations or operations in urology, gynecology or proctology. The lithotomy position is also used as a common position for childbirth. The term lithotomy refers to the historical techniques of bladder stone therapy, as in former ages perineal access routes to the stone were common (sectio lateralis and sectio mediana).
Technique of the Lithotomy Position
The patient lies on his back, 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 access to the prostate requires extreme lithotomy position. With additional flexion of the lumbar spine, lifting of the buttocks (oblique positioning cushion) and increased flexion of the hip joint, the perineum can be aligned parallel to the floor. The legs must be mounted in special holders. The padding of all the relevant pressure points is of paramount importance.
Complications of the Lithotomy Position
Very rare: compartment syndrome of the leg, nerve injury by pressure (femoral nerve or peroneal nerve). Risk factors include long time period of the lithotomy position or/and a strong flexion and rotation of the hip joint.
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.
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