title: Rhabdomyolysis and acute renal failure following prolonged surgery in the lithotomy position.
abstract: Operative positions commonly used in urogenital surgeries when perineal exposure is required include the lithotomy and the exaggerated lithotomy positions (LPs), which expose patients to the risk of rhabdomyolysis. We report a patient with bladder outflow obstruction, benign prostatic hypertrophy and a very large bladder stone, which was removed with cystoscopy and cystolitholapaxy in the LP. The procedure was complicated by posterior bladder perforation and abdominal distention leading to prolonged surgery duration (5.5 h). The patient developed rhabdomyolysis and acute renal failure (ARF) without compartmental syndrome. On the other hand, there was a potential role of glycine solution, used for bladder irrigation, in the appearance of ARF. Overall, our case shows that rhabdomyolysis and ARF can develop in operative positions, and duration of surgery is the most important risk factor for such complications.
authors.affiliation: Department of Nephrology, Fahd Military Medical Complex, Dhahran, Saudi Arabia. guella@gmail.com
authors.forename: Adnane
authors.initials: A
authors.lastname: Guella
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Al Oraifi
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000628:therapy; D000369:Aged, 80 and over; D003558:Cystoscopy; D005998:Glycine / Q000009:adverse effects; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects*; D008297:Male; D056888:Patient Positioning / Q000009:adverse effects*; D006435:Renal Dialysis; D012206:Rhabdomyolysis / Q000209:etiology*; D012307:Risk Factors; D007507:Therapeutic Irrigation / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000293:injuries / Q000601:surgery; D001744:Urinary Bladder Calculi / Q000601:surgery*; D014950:Wounds, Penetrating / Q000209:etiology / Q000601:surgery
chemical_list: D005998:Glycine