PURPOSE Urologists encounter multiple challenges in managing ureteral stones with ureteroscopic laser lithotripsy. This meta-analysis assesses the effectiveness of alternative surgical positioning, Reverse Trendelenburg (RevTren) and Trendelenburg (Tren), in reducing stone migration and enhancing outcomes compared with standard dorsal lithotomy positioning. MATERIALS AND METHODS A systematic review was conducted following PRISMA guidelines, searching Medline, Embase, Scopus, Cochrane, and WoS up to March 2024. This review focused on studies evaluating RevTren or Tren positioning during ureteroscopic lithotripsy compared with standard dorsal lithotomy, analyzing end points such as stone migration, conversion rates, success rates, complications, and operative time. RESULTS Of 137 studies identified, 8 met the inclusion criteria, encompassing 1374 patients. RevTren significantly reduced ureteral stone migration (odds ratio [OR], 0.20; 95% CI, 0.08-0.47), lowered the need for conversion to a flexible ureteroscope (OR, 0.28; 95% CI, 0.12-0.67), and improved success rates (OR, 2.90; 95% CI, 1.88-4.48). Tren increased migration of ureteral and calyceal stones toward upper renal calyces (OR, 2.12; 95% CI, 1.48-3.04) and achieved a higher success rate (OR, 3.56; 95% CI, 2.15-5.92). Complications were comparable across all positions. CONCLUSION Adjusting patient positioning during ureteroscopic laser lithotripsy can enhance procedure outcomes. RevTren effectively reduces ureteral stone migration and the necessity for flexible ureteroscopes, whereas Tren facilitates ureteral and calyceal stone migration toward upper calyces, increasing success rates. Both positioning techniques offer significant advantages over standard positioning and can be safely adopted in clinical practice without compromising patient safety.

中文翻译：

---

特伦德伦伯卧位或反向特伦德伦伯卧位对输尿管镜碎石手术的影响：系统评价和荟萃分析。


目的 泌尿科医生在用输尿管镜激光碎石术治疗输尿管结石时遇到多重挑战。本荟萃分析评估了与标准背侧截石定位相比，替代手术体位反向特伦德伦伯卧位 （RevTren） 和特伦德伦伯卧位 （Tren） 在减少结石迁移和提高结局方面的有效性。材料和方法 按照 PRISMA 指南进行了系统评价，检索了截至 2024 年 3 月的 Medline、Embase、Scopus、Cochrane 和 WoS。本综述侧重于评估输尿管镜碎石术与标准背侧截石术中 RevTren 或 Tren 定位的研究，分析结石迁移、转化率、成功率、并发症和手术时间等终点。结果 在确定的 137 项研究中，8 项符合纳入标准，涉及 1374 名患者。RevTren 显著减少了输尿管结石迁移 （比值比 [OR]，0.20;95% CI，0.08-0.47），降低了改用输尿管软镜的需要 （OR，0.28;95% CI，0.12-0.67），提高了成功率 （OR，2.90;95% CI，1.88-4.48）。Tren 增加了输尿管结石和肾盏向上肾盏的迁移 （OR， 2.12;95% CI， 1.48-3.04） 并取得了更高的成功率 （OR， 3.56;95% CI， 2.15-5.92）。所有位置的并发症均具有可比性。结论 在输尿管镜激光碎石术中调整患者体位可以提高手术结局。RevTren 可有效减少输尿管结石迁移和对输尿管软镜的必要性，而 Tren 可促进输尿管结石和肾盏向上肾盏迁移，从而提高成功率。 与标准定位相比，这两种定位技术都具有显著优势，并且可以在临床实践中安全采用，而不会影响患者安全。