Lower Extremity Complications After Urethroplasty in Extended Lithotomy: A Case Series and Review

Urethroplasty, often performed in the extended lithotomy position, may lead to rare but serious lower extremity complications due to prolonged positioning.This case series describes three patients with complications post-urethroplasty and reviews risk factors and preventive strategies.Between 2023 and 2024, 76 urethroplasties were performed at our center.All patients were in the age group of 18-70 years.We report three cases of lower extremity complications -well leg compartment syndrome (WLCS), deep venous thrombosis (DVT), and femoral neuropathy-in patients undergoing urethroplasty in extended lithotomy.Case 1 (23-year-old male) developed WLCS post-stage 1 urethroplasty, managed with four-compartment fasciotomy and skin grafting, with full recovery.Case 2 [55-year-old male, body mass index (BMI) 26, prior pelvic fracture] experienced femoral neuropathy after progressive perineal urethroplasty.The condition was treated with dexamethasone, and he recovered fully within one month.Case 3 (68-year-old male, prior pelvic fracture) developed DVT, post-progressive perineal urethroplasty, which was resolved with heparin and warfarin.Risk factors included prolonged surgery (4-4.5 hours), extended lithotomy, high BMI, and prior pelvic trauma.Lower extremity complications post-urethroplasty are rare but debilitating.Preventive measures, including optimized limb support, intermittent decompression, and surgical efficiency, are critical, especially in high-risk patients (e.g., those with pelvic trauma or obesity).