The T-Tilt Position: A Novel Modified Patient Position to Improve Stone-Free Rates in Retrograde Intrarenal Surgery

No AccessJournal of UrologyAdult Urology1 Nov 2021The T-Tilt Position: A Novel Modified Patient Position to Improve Stone-Free Rates in Retrograde Intrarenal SurgeryThis article is commented on by the following:Editorial Comment Christine W. Liaw, Johnathan A. Khusid, Blair Gallante, Jake N. Bamberger, William M. Atallah, and Mantu Gupta Christine W. LiawChristine W. Liaw *Correspondence: Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl., New York, 10029New York telephone: 212-241-4812; FAX: 937-458-5838; E-mail Address: [email protected] Icahn School of Medicine at Mount Sinai, New York, New York Mayo Clinic, Department of Urology, Rochester, Minnesota , Johnathan A. KhusidJohnathan A. Khusid Icahn School of Medicine at Mount Sinai, New York, New York , Blair GallanteBlair Gallante Icahn School of Medicine at Mount Sinai, New York, New York , Jake N. BambergerJake N. Bamberger Icahn School of Medicine at Mount Sinai, New York, New York , William M. AtallahWilliam M. Atallah Icahn School of Medicine at Mount Sinai, New York, New York , and Mantu GuptaMantu Gupta Icahn School of Medicine at Mount Sinai, New York, New York View All Author Informationhttps://doi.org/10.1097/JU.0000000000001948AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Residual fragments following retrograde intrarenal surgery can lead to future stone episodes. The lower pole of the kidney presents a unique challenge as it is the most difficult location for retrograde intrarenal surgery. We investigated a modified patient position to increase stone-free rate by analyzing presence of residual fragments. We randomized patients into standard position and the T-Tilt position (15° Trendelenburg and 15° airplane away from the surgical side kidney). Materials and Methods: In this prospective, randomized study, patients were randomized into the standard or T-Tilt position. Demographics, comorbidities and operative parameters were collected. Stone-free rate was determined with renal ultrasound and x-ray at 1-month followup. Postoperative complications were recorded up to 1 month. Variables were compared using Kruskal-Wallis test for continuous variables and chi-square test for categorical variables. Results: A total of 138 patients were analyzed: 75 standard patients and 63 T-Tilt patients. The groups had similar patient and stone factors. The most common stone position was the lower pole (68.0% standard, 74.6% T-Tilt). Stone-free rates were significantly different: standard position was 76.7% and T-Tilt position was 92.1% (p=0.015). Stone-free rates for isolated lower pole stones were significantly different as well: standard position was 68.2% and T-Tilt position was 95.6% (p <0.001). Clavien-Dindo scores did not differ significantly (p=0.262). Conclusions: The T-Tilt patient position was associated with higher stone-free rates. 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Available at http://www.consort-statement.org/consort-statement/flow-diagram. Google Scholar All human subjects provided written informed consent with guarantees of confidentiality. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited BySmith J (2021) This Month in Adult UrologyJournal of Urology, VOL. 206, NO. 5, (1083-1084), Online publication date: 1-Nov-2021.Related articlesJournal of UrologyAug 11, 2021, 12:00:00 AMEditorial Comment Volume 206Issue 5November 2021Page: 1232-1239 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordsureteroscopypatient positioningurologic surgical proceduresurinary calculiMetricsAuthor Information Christine W. Liaw Icahn School of Medicine at Mount Sinai, New York, New York Mayo Clinic, Department of Urology, Rochester, Minnesota *Correspondence: Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl., New York, 10029New York telephone: 212-241-4812; FAX: 937-458-5838; E-mail Address: [email protected] More articles by this author Johnathan A. Khusid Icahn School of Medicine at Mount Sinai, New York, New York More articles by this author Blair Gallante Icahn School of Medicine at Mount Sinai, New York, New York More articles by this author Jake N. Bamberger Icahn School of Medicine at Mount Sinai, New York, New York More articles by this author William M. Atallah Icahn School of Medicine at Mount Sinai, New York, New York More articles by this author Mantu Gupta Icahn School of Medicine at Mount Sinai, New York, New York More articles by this author Expand All All human subjects provided written informed consent with guarantees of confidentiality. Advertisement PDF DownloadLoading ...