Impact of Trendelenburg vs. Reverse Trendelenburg Positioning for Ureteroscopy: A Systematic Review with Ultrasound Insights

This meta-analysis investigates the impact of patient positioning during ureteroscopic laser lithotripsy (URS) on the management of ureteral stones. The study compares two alternative positions—Reverse Trendelenburg (RevTren) and Trendelenburg (Tren)—against the standard dorsal lithotomy position. A systematic review was conducted according to PRISMA guidelines, analyzing eight studies involving 1,374 patients. Results indicated that RevTren significantly reduced ureteral stone migration (odds ratio [OR], 0.20; 95% CI, 0.08-0.47) and the need for conversion to flexible ureteroscopy (OR, 0.28; 95% CI, 0.12-0.67). It also improved success rates (OR, 2.90; 95% CI, 1.88-4.48). Conversely, Tren was associated with increased migration of ureteral stones toward the upper renal calyces (OR, 2.12; 95% CI, 1.48-3.04) and yielded a higher success rate (OR, 3.56; 95% CI, 2.15-5.92). Notably, complications were comparable across all positions, suggesting safety in implementing these adjustments. The findings underscore the potential of adjusting patient positioning as a valuable strategy to enhance outcomes in URS procedures, thereby facilitating stone removal and minimizing the need for additional interventions. This systematic review emphasizes the importance of optimizing patient positioning during ureteroscopy to mitigate stone retropulsion and improve overall procedural efficacy, positioning both RevTren and Tren as significant alternatives to the conventional dorsal lithotomy. Ultimately, integrating these techniques into clinical practice may lead to improved patient outcomes and greater efficiency in the management of ureteral stones.