Impact of obesity on ureteroscopic laser lithotripsy of urinary tract calculi

Natalin, Ricardo A.; Xavier, Keith; Okeke, Zephaniah; Gupta, Mantu

doi:10.1590/s1677-55382009000100006

Cited by 21 publications

(26 citation statements)

References 20 publications

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“…Results from a retrospective, single-institution study showed that the stone-free rates among 107 obese and non-obese patients were similar. [22] Another study by Best et al [23] also showed similar success rates. However, these studies provided only limited information regarding intra-and postsurgical anesthesia-related complication rates in obese patients.…”

Section: Discussionmentioning

confidence: 76%

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: 76%

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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“…Furthermore, ureteroscopy does not appear to be affected by body habitus. In a retrospective, single institution study, the stone free rates were similar between 107 obese patients and non-obese patients (21). Another recent study published by Best et al (22) showed statistically equivalent SFR in obese (91%) and non-obese (81%) patients who underwent flexible URS for proximal ureteral stones.…”

Section: Discussionmentioning

confidence: 82%

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 may be a suboptimal treatment for obese patients since positioning of the patient for an optimal stone fragmentation is a limiting factor [7] . Most lithotripters have a maximum skin to stone distance of 12-14 cm for their focal point and thus can restrict the acquired distance for complete stone fragmentation in obese patients [7,27] .…”

Section: Management Of Obese Patients With Urolithiasismentioning

confidence: 99%

“…Most lithotripters have a maximum skin to stone distance of 12-14 cm for their focal point and thus can restrict the acquired distance for complete stone fragmentation in obese patients [7,27] . Similar difficulties may also decrease the success rate of a percutaneous nephrolithotomy (PCNL) procedure in an obese patient with nephrolithiasis due to difficulties in percutaneous access, as well as limitations in the use of normal sized instruments and higher risk of anesthetic complications in prone position [7] . In contrast, El-Assmy et al [28] showed that PCNL in obese patients is a safe method with similar success rates, morbidity and operative time.…”

Section: Management Of Obese Patients With Urolithiasismentioning

confidence: 99%

“…Recently, a common pathophysiology has been advocated for both diseases, since several investigations have mentioned that the prevalence of urolithiasis has been increasing in parallel with obesity [2,3,6] . Various lithogenic risk factors, including increased body mass index (BMI), low urinary volume, hypercalciuria, hyperoxaluria and hyperinsulinemia, are associated with obesity [7] . A recent trial found that 98% of obese patients had at least one lithogenic risk factor in a-24 h urine sample and 80% had 3 or more factors [8] .…”

Section: Introductionmentioning

confidence: 99%

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Urinary stone disease and obesity: Different pathologies sharing common biochemical mechanisms

Aydoğdu¹

2012

WJN

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The prevalence of urolithiasis is increasing in parallel with the escalating rate of obesity worldwide. It has previously been speculated that obesity is a potential risk factor for urinary stone disease. The possibility that common biochemical mechanisms underlie both obesity and urolithiasis is remarkable. Better understanding of possible common mechanisms of these diseases could potentially lead to a better management of urinary stone prevention. The prevention of urinary stone formation gives clinicians an acceptable reason to encourage lifestyle modification and weight loss through a regular diet. In this review, the association of obesity with urinary stone disease, possible common biochemical mechanisms, effects of dietary habits and weight loss on stone formation, as well as difficulties in surgical management of obese individuals with urolithiasis are discussed.

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Impact of obesity on ureteroscopic laser lithotripsy of urinary tract calculi

Cited by 21 publications

References 20 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?

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

Urinary stone disease and obesity: Different pathologies sharing common biochemical mechanisms

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