Lepine Henrique L, Vicentini Fabio C, Molina Wilson R, Llata Carolina M, Marchini Giovanni S, Torricelli Fabio C M, Batagello Carlos A, Danilovic Alexandre, Nahas William C, Mazzucchi Eduardo
University of São Paulo School of Medicine, São Paulo, Brazil.
Department of Urology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
J Urol. 2025 Jan;213(1):8-19. doi: 10.1097/JU.0000000000004258. Epub 2024 Sep 30.
Urologists encounter multiple challenges in managing ureteral stones with ureteroscopic laser lithotripsy. This meta-analysis assesses the effectiveness of alternative surgical positioning, reverse Trendelenburg (RevTren) and Trendelenburg (Tren), in reducing stone migration and enhancing outcomes compared with standard dorsal lithotomy positioning.
A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching MEDLINE, Embase, Scopus, Cochrane, and Web of Science up to March 2024. This review focused on studies evaluating RevTren or Tren positioning during ureteroscopic lithotripsy compared with standard dorsal lithotomy, analyzing end points such as stone migration, conversion rates, success rates, complications, and operative time.
Of 137 studies identified, 8 met the inclusion criteria, encompassing 1374 patients. RevTren significantly reduced ureteral stone migration (odds ratio [OR], 0.20; 95% CI, 0.08-0.47), lowered the need for conversion to a flexible ureteroscope (OR, 0.28; 95% CI, 0.12-0.67), and improved success rates (OR, 2.90; 95% CI, 1.88-4.48). Tren increased migration of ureteral and calyceal stones toward upper renal calyces (OR, 2.12; 95% CI, 1.48-3.04) and achieved a higher success rate (OR, 3.56; 95% CI, 2.15-5.92). Complications were comparable across all positions.
Adjusting patient positioning during ureteroscopic laser lithotripsy can enhance procedure outcomes. RevTren effectively reduces ureteral stone migration and the necessity for flexible ureteroscopes, whereas Tren facilitates ureteral and calyceal stone migration toward upper calyces, increasing success rates. Both positioning techniques offer significant advantages over standard positioning and can be safely adopted in clinical practice without compromising patient safety.
泌尿外科医生在使用输尿管镜激光碎石术治疗输尿管结石时面临多种挑战。本荟萃分析评估了与标准仰卧位截石术相比，替代手术体位，即头高脚低位（RevTren）和头低脚高位（Tren），在减少结石移位和改善治疗结果方面的有效性。
按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行系统评价，检索截至2024年3月的MEDLINE、Embase、Scopus、Cochrane和科学网。本评价重点关注评估输尿管镜碎石术中RevTren或Tren体位与标准仰卧位截石术相比的研究，分析结石移位、转换率、成功率、并发症和手术时间等终点指标。
在识别出的137项研究中，8项符合纳入标准，涵盖1374例患者。RevTren显著减少输尿管结石移位（比值比[OR]，0.20；95%置信区间，0.08 - 0.47），降低了转换为软性输尿管镜的必要性（OR，0.28；95%置信区间，0.12 - 0.67），并提高了成功率（OR，2.90；95%置信区间，1.88 - 4.48）。Tren增加了输尿管和肾盏结石向上肾盏的移位（OR，2.12；95%置信区间，1.48 - 3.04），并获得了更高的成功率（OR，3.56；95%置信区间，2.15 - 5.92）。所有体位的并发症相当。
输尿管镜激光碎石术中调整患者体位可改善手术效果。RevTren有效减少输尿管结石移位和使用软性输尿管镜的必要性，而Tren促进输尿管和肾盏结石向上肾盏移位，提高成功率。这两种体位技术均比标准体位具有显著优势，且可在不影响患者安全的情况下安全地应用于临床实践。
