Extracorporeal shock wave lithotripsy success based on body mass index and Hounsfield units

Pareek, Gyan; Armenakas, Noel A.; Panagopoulos, Georgia; Bruno, J. James; Fracchia, John A.

doi:10.1016/j.urology.2004.08.004

Cited by 190 publications

(151 citation statements)

References 8 publications

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“…[7,14] According to recent studies, the overall stone-free rate at 3 months after ESWL is 68% in obese patients and 80%-85% in non-obese patients. [15] The utility of BMI in predicting ESWL success is variable.…”

Section: Discussionmentioning

confidence: 99%

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Does morbid obesity influence the success and complication rates of extracorporeal shockwave lithotripsy for upper ureteral stones?

Dede¹,

Şener²,

Baş³

et al. 2015

Turkish Journal of Urology

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Objective: The aim of the current study was to investigate whether obesity influences the outcome of extracorporeal shockwave lithotripsy (ESWL) treatment for upper ureteral stones. Material and methods:This is a retrospective study of 134 patients who underwent ESWL between June 2011 and May 2014. Patients were divided into 2 groups. Group 1 comprised 94 patients of normal weight, and group 2 comprised 40 morbidly obese patients. Patients in both groups had upper ureteral stones. Results:The mean age of groups 1 and 2 was 45.6±12.1 and 45.3±15.5 years, respectively (p=0.98). There was no significant difference in demographic variables between the groups. The mean stone size in groups 1 and 2 was 81.7±25.7 mm² and 86.3±22.4 mm², respectively (p= 0.51), the mean body mass index (BMI) was 27.4±2.9 and 42.9±2.1, respectively (p<0.01), the mean number of ESWL sessions was 2.4±0.6 and 2.4±0.7, respectively (p= 0.97), and the mean follow-up time was 7.1±3.4 and 6.6±2.8 weeks, respectively (p= 0.67). The overall stone-free rate was 82% in group 1 and 67% in group 2 (p=0.01). Conclusion:It is well-known that morbidly obese patients have higher rates of anesthesia-related problems due to the comorbidities commonly observed in this population. In the current study, we found that ESWL is a safe and acceptable treatment option for morbidly obese patients with upper ureteral stones.

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Section: Discussionmentioning

confidence: 99%

“…[6] It is not clear which of these factors influences treatment outcomes the most. [7] Therefore, the goal of the current study was to investigate whether obesity affects the treatment outcomes and complication rates of ESWL for ureteral stones.…”

Section: Introductionmentioning

confidence: 99%

Does morbid obesity influence the success and complication rates of extracorporeal shockwave lithotripsy for upper ureteral stones?

Dede¹,

Şener²,

Baş³

et al. 2015

Turkish Journal of Urology

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“…BMI as well as fat distribution affects the outcome of extracorporeal shock wave lithotripsy (ESWL). In two studies, increasing BMI and increasing stone-to-skin distance were shown to decrease success of ESWL treatment for renal stones [8,9]. Increasing BMI has also been shown to increase operative times during laparoscopic radical prostatectomy [2].…”

Section: Discussionmentioning

confidence: 99%

Gender differences in subcutaneous and perirenal fat distribution

et al. 2010

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Purpose Body mass index (BMI) has been shown to influence the outcome of various surgical procedures. The purpose of this study is to assess the relationship between BMI, gender, and the distribution of subcutaneous and perirenal fat. Methods A retrospective review was performed for 123 patients who underwent radical or partial nephrectomy. Preoperative CT scans were reviewed by two independent observers. Subcutaneous fat was measured at three locations and perirenal fat was measured at six locations. Statistical analysis was performed using the Student's t test and the Pearson's correlation coefficient. Results Mean anterior subcutaneous fat was significantly greater in females than in males (2.54 vs. 1.78 cm, p \ 0.001) as was mean right posterolateral subcutaneous fat (2.78 vs. 2.21 cm, p = 0.03). With regard to perirenal fat, men were greater than women for all perirenal locations around the left kidney. For the right kidney, men were greater than women for four out of six perirenal positions. In both men and women, BMI was strongly correlated with subcutaneous fat. However, BMI was weakly correlated with perirenal fat. Conclusions Women exceed men in subcutaneous fat, while men exceed women in perirenal fat. Obese patients are very likely to have large amounts of subcutaneous fat, but will not necessarily have proportionally increased fat around their kidneys when compared to the patients with lower BMI. These differences may have important implications for surgical approaches to the kidney.

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“…Each stone was stratified by skin to stone distance (SSD), which is commonly measured for SWL but not typically for URS. SSD was calculated by measuring the average of three distances ( Figure-1A) from the center of the stone to skin at 0, 45 and 90 angles on non-contrast preoperative CT as previously described (7).…”

Section: Methodsmentioning

confidence: 99%

“…Despite of the fact that SWL represents a highly successful non-invasive treatment in urolithiasis, several studies have demonstrated diminished efficacy in obese patients since this technique is considerably affected by skin-to-stone distances (6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Outcomes of intracorporeal lithotripsy of upper tract stones is not affected by BMI and skin-to-stone distance (SSD) in obese and morbid patients

et al. 2013

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Purpose: The purpose of this study is to determine if body mass index (BMI) and stone skin distance (SSD) affect stone free rate (SFR) in obese and morbid obese patients who underwent flexible URS for proximal ureteral or renal stones < 20 mm. Materials and Methods: A retrospective chart review was performed of consecutive patients that underwent flexible URS. Inclusion criteria were: proximal ureteral stones and renal stones less than 20 mm in the preoperative computed tomography (CT). SFR were then compared according to SSD and BMI. Results: A total of 153 patients were eligible for this analysis, 49 (32.02%) with SSD < 10 cm and 104 (67.97%) with SSD ≥ 10 cm. The mean stone size was 10.5 ± 6.4 mm. The overall SFR in our study was 82.4%. The SFR for the SSD < 10 and ≥ 10 were 79.6% and 83.7% respectively (p = 0.698) and for BMI < 30, ≥ 30 and < 40 and ≥ 40 were 82.9%, 81.7% and 90.9% respectively. Regression analysis showed no affect between BMI or SSD regarding SFR. Conclusion: Ureteroscopy should be considered as a first-line of treatment for renal/proximal stones in obese and morbid obese patients. URS may be preferable to SWL in obese patients independently of the SSD, BMI or the location of proximal stones. INTRODuCTIONThe ideal treatment for proximal ureteral and renal stones has become controversial, with the noninvasive nature of shock wave lithotripsy (SWL) and the expansion of endoscopic digital technology. The 2007 update of the EAU/AUA ureteral stone guidelines (1) showed that both ureteroscopy (URS) and SWL should be considered first-line therapy for proximal ureteral stones, as opposed to just SWL as previously reported. On the other hand SWL has emerged as the primary treatment of choice for renal calculi less than 1.5-2 cm (2).In that context, the treatment of urolithiasis in obese patients has gained more importance in the last years since obesity rates have increased markedly since 1980 in the United States (3). Data from the national Center for Health Statistics (2009Statistics ( -2010 showed that 35.7% of adults and 17% of children and adolescents in the United States were obese (4). According to the World Health Organization guidelines, a body mass index (BMI) of 18.5 to 25 kg/m 2 is considered normal, overweight is a BMI of 25 to Outcomes of intracorporeal lithotripsy of upper tract stones is not affected by BMI and skin-to-stone distance (SSD) in obese and morbid patients _______________________________________________

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Extracorporeal shock wave lithotripsy success based on body mass index and Hounsfield units

Cited by 190 publications

References 8 publications

Does morbid obesity influence the success and complication rates of extracorporeal shockwave lithotripsy for upper ureteral stones?

Does morbid obesity influence the success and complication rates of extracorporeal shockwave lithotripsy for upper ureteral stones?

Gender differences in subcutaneous and perirenal fat distribution

Outcomes of intracorporeal lithotripsy of upper tract stones is not affected by BMI and skin-to-stone distance (SSD) in obese and morbid patients

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