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A retrospective review of 48 consecutive morbidly obese patients with urolithiasis who were treated successfully by endoscopic modalities over 3.5 years was performed. Of the 73 endoscopic procedures, 48 were ureteroscopic laser lithotripsy (UL), 4 were ureteroscopic basket extraction, and 21 were percutaneous nephrolithotripsy (PCNL). The patients' weight ranged from 205 to 385 lbs. (average 286 lbs.). Their abdominal girth ranged from 53 to 65 inches (average 59 inches). Twenty-six patients had one procedure, eight patients had bilateral procedures, eleven patients had two procedures, and three patients had three procedures with utilization of either multiple ureteroscopic treatments or the combination of percutaneous and ureteroscopic techniques. The stone-free rate after one procedure was 77.8% for UL and 60% for PCNL. The stone-free rate after planned repeat procedures was 97% for UL/UL and 89% for PCNL/UL. There were two minor complications. Forty-eight procedures were performed on an outpatient basis, and the remaining 25 procedures necessitated hospital admission (average 3.6 days). Morbidly obese patients with urolithiasis who are unable to have SWL because of their body weight and abdominal girth can be treated successfully with UL, ureteroscopic basket extraction, and PCNL with efficacy comparable to that in patients of normal weight and with minimal morbidity. Many renal calculi were treated with UL alone with a high success rate.

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The in vitro effects of a calcium channel antagonist (nifedipine) and agonist (BAY K8644) on the neurogenic responses of the streptozotocin-induced diabetic rat bladder were investigated. The bladder body and bladder base were studied separately. There were no significant differences in neurogenic responses in diabetic bladder body compared to control body, but the diabetic bladder base demonstrated an increased contractile response at each frequency compared to control base. The rate of contractile response was similar in controls and diabetics but was significantly different between body and base. Although declining with time, contractile responses in the diabetic bladder body and base were increased from control in the absence of extracellular calcium. Differences were found in effects upon maximum responses between diabetic and control tissues treated with nifedipine and BAY K8644. BAY K8644 did not completely reverse the effect of nifedipine on the neurogenic responses in the diabetic bladder body. Effects of diabetes on the bladder body and base are associated with changes in calcium channel activity of bladder smooth muscle.