title: Simultaneous antegrade/retrograde upper urinary tract access: Bart's modified lateral position for complex upper tract endourologic pathologic features.
abstract: OBJECTIVE
  To determine whether the Bart's modified lateral position is safe and effective for achieving simultaneous anterograde and retrograde access in complex upper urinary tract pathologic features.
  
  
  METHODS
  From November 2006 to September 2010, 45 procedures were performed, with the patients in the modified lateral position. The indication for these procedures was the presence of complex unilateral upper urinary tract pathologic features. The patients with muscular and/or skeletal abnormalities were excluded. All procedures were performed using simultaneous anterograde and retrograde access with the patient under general anesthesia.
  
  
  RESULTS
  The preoperative investigation protocol included assessment of the stone burden and location using enhanced abdominal computed tomography. The patients were routinely examined 6 weeks after the procedure with a combination of plain abdominal radiography and renal ultrasonography. For patients treated for conditions causing upper urinary tract obstruction (pelviureteral junction obstruction and/or ureteral strictures), a mercaptoacetyltriglycine renography was performed at 4, 12, and 24 months postoperatively. The mean patient age was 51.2 years (range 17-79). Stone clearance was achieved by a single combined procedure in 36 patients (80%). Successful recanalization was achieved in all patients with pelviureteral junction obstruction and ureteral strictures. In 4 patients (8.8%), persistent hematuria was noted, and 2 patients (4.4%) developed postoperative urinary sepsis and were treated conservatively.
  
  
  CONCLUSIONS
  Modification to the lateral position compares equally with contemporary percutaneous nephrolithotomy series. It provides wide exposure of the flank, allowing the choice of multiple access sites, enhanced control, and a wide angle for handling of the antegrade instruments. Two surgeons can work simultaneously, addressing complex endourologic pathologic features in high-risk patients.
authors: Endourology and Stone Services, Department of Urology, St. Bartholomew's Hospital and The London National Health Service Trust, London, United Kingdom. konstantinos.moraitis@bartsandthelondon.nhs.uk
authors: Konstantinos
authors: K
authors: Moraitis
authors: Prodromos
authors: P
authors: Philippou
authors: Tamer
authors: T
authors: El-Husseiny
authors: Hassan
authors: H
authors: Wazait
authors: Junaid
authors: J
authors: Masood
authors: Noor
authors: N
authors: Buchholz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006417:Hematuria / Q000209:etiology; D006801:Humans; D007682:Kidney Pelvis / Q000293:injuries; D053844:Lasers, Solid-State; D017602:Lithotripsy, Laser; D008297:Male; D008875:Middle Aged; D053040:Nephrolithiasis / Q000000981:diagnostic imaging / Q000601:surgery*; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D011187:Posture; D011300:Preoperative Care; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000601:surgery; D053039:Ureterolithiasis / Q000000981:diagnostic imaging / Q000601:surgery*; D014552:Urinary Tract Infections / Q000209:etiology; D014567:Urography; D055815:Young Adult