title: The split-leg modified lateral position for percutaneous renal surgery and optimal retrograde access to the upper urinary tract.
abstract: OBJECTIVE
  To present our experience with percutaneous nephrolithotomy (PCNL) in the split-leg modified lateral position.
  
  
  METHODS
  The patient is placed with the thorax in the lateral position and the pelvis in an oblique position. Then the lower limbs are split and bent in the lowest position. Initial placement of a retrograde ureteral catheter, tract formation, stone fragmentation and retrieval, and optional extra procedures were accomplished with the patient in the same position.
  
  
  RESULTS
  PCNL in the split-leg modified lateral position resulted in decreased operating room time, less manipulation of the anesthetized patient, and maintaining the sterility of the retrograde ureteral catheter. In addition, it allowed simultaneous antegrade and retrograde endoscopic approach to the upper urinary tract. Ureteral catheter placement, PCNL, and associated procedures were possible in all patients. Adjunct procedures were internal urethrotomy, transurethral resection of the prostate, rigid and flexible ureteroscopy, and endopyelotomy or endopyeloplasty.
  
  
  CONCLUSIONS
  Performing PCNL in the split-leg modified lateral position has several advantages for the patient and the urologist, with greater versatility of stone manipulation along the entire urinary tract.
authors: Department of Urology, Military Hospital Moulay Ismail, Méknes, Morocco. lezrekmohamed@yahoo.com
authors: Mohammed
authors: M
authors: Lezrek
authors: Abdelghani
authors: A
authors: Ammani
authors: Khalil
authors: K
authors: Bazine
authors: Mohammed
authors: M
authors: Assebane
authors: El Hassan
authors: el H
authors: Kasmaoui
authors: Abdelmounim
authors: A
authors: Qarro
authors: Amoqrane
authors: A
authors: Beddouch
authors: Mohammed
authors: M
authors: Alami