title: Rhabdomyolysis and myogloginuric acute renal failure in the lithotomy/exaggerated lithotomy position of urogenital surgeries.
abstract: OBJECTIVE
  To evaluate rhabdomyolysis and it's management in lithotomy and the exaggerated lithotomy positions during urogenital surgeries.
  
  
  METHODS
  Retrospective study
  
  
  METHODS
  Institute of Post Graduate Medical Education and Research (IPGME & R), Kolkata, India.
  
  
  METHODS
  Patients undergoing urogenital surgeries (lithotomy and the exaggerated lithotomy positions).
  
  
  METHODS
  All four cases of rhabdomyolysis which occurred after such positional urogenital surgeries were treated with conservative management for prolonged period with hemodialysis. One case which developed compartment syndrome underwent fasciotomy and also managed with conservative approach as other cases.
  
  
  METHODS
  Rhabdomylysis is now a rare complication in any open or laparoscopic surgery. But prolonged lithotomy or exaggerated lithotomy position surgeries have been shown to expose patients to the risk of rhabdomylysis and acute renal failure.
  
  
  RESULTS
  In our institute patients undergoing urogenital surgeries in lithotomy and the exaggerated lithotomy positions only developed rhabdomyolysis and myogloginuric acute renal failure. All procedures were of prolonged duration (mean five hours and ten minutes). Three patients developed rhabdomyolysis and acute renal failure without compartmental syndrome and one with compartmental syndrome. Rhabdomyolysis with the appearance of acute renal failure is discussed.
  
  
  CONCLUSIONS
  Overall, our cases showed that rhabdomyolysis and acute renal failure can develop in such operative positions even in the absence of compartmental syndrome, and that duration of surgery is the most important risk factor for such complications. So we should be careful regarding duration of surgery in lithotomy procedure to prevent such morbid complications.
authors: Department of Urology, Institute of Postgraduate Medical Education and Research and SSKM Hospital, Kolkata, India.
authors: Mukesh K
authors: MK
authors: Vijay
authors: Preeti
authors: P
authors: Vijay
authors: Anup K
authors: AK
authors: Kundu