The reverse Trendelenburg position in proximal ureteral stone management: A systematic review and meta-analysis

Abstract

Introduction: Ureteroscopy lithotripsy (URSL) presents a therapeutic option for patients with proximal ureteral calculi warranting active removal. This systematic review and meta-analysis aimed to assess the efficacy of the reverse Trendelenburg (RT) position during this procedure.

Materials: A comprehensive literature search was conducted across PubMed, Embase, and Cochrane databases to identify randomized controlled trials and observational studies comparing RT versus standard positioning (STD) in patients undergoing URSL for proximal ureteral stones. Heterogeneity was measured with the Cochran's Q test, I² statistics, and prediction intervals (PI). A DerSimonian and Laird random-effects model was utilized for all outcomes.

Results: Four studies encompassing 505 patients undergoing URSL were analyzed. Among the studied participants, 293 (58%) underwent RT positioning. Overall, RT was associated with a lower average incidence of stone retropulsion (RR 0.42; 95% CI 0.27-0.65; I²=48%; PI 0.08-2.10) and a higher mean stone-free rate (RR 1.33; 95% CI 1.18-1.49; I²=0%). However, no significant difference between groups was found in the mean rate of overall complications (RR 0.76; 95% CI 0.40-1.43; I²=51%; PI 0.00-520.22) and operative time (MD -0.65; 95% CI -9.58-8.27; I²=94%; PI -111.95-110.65). In those with proximal ureteral stones undergoing RT positioning at only the 20° angle, there was a reduction in stone retropulsion without any measured heterogeneity (RR 0.35; 95% CI 0.23-0.52; I²=0%).

Conclusion: These findings suggest that RT positioning is effective in improving outcomes for patients with proximal ureteral stones undergoing URSL, and its use should be considered during the procedure.

Keywords: Calculs urétéraux; Head-down tilt; Lithotripsie; Lithotripsy; Meta-analysis as topic; Méta-analyse comme sujet; Position déclive; Ureteral calculi; Urolithiase; Urolithiasis.