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Dede O et al, 2015: Does morbid obesity influence the success and complication rates of extracorporeal shockwave lithotripsy for upper ureteral stones?

Dede O, Şener NC, Baş O, Dede G, Bağbancı MŞ.
Department of Urology, Dicle University Faculty of Medicine, Diyarbakır, Turkey.
Department of Urology, Ministry of Health Numune Training and Research Hospital, Ankara, Turkey.
Department of Urology Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey.
Department of Clinical Microbiology and Infectious Diseases, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey.
Department of Urology, Ahi Evran University Faculty of Medicine, Kırşehir, Turkey.

Abstract

OBJECTIVE: The aim of the current study was to investigate whether obesity influences the outcome of extra-corporeal 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 mm(2) and 86.3±22.4 mm(2), 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.

Turk J Urol. 2015 Mar;41(1):20-3. doi: 10.5152/tud.2015.94824. 

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Comments 1

Peter Alken on Wednesday, 16 December 2015 09:22

An electrohydraulic lithotripter (Multimed Classic; Elmed) with a “penetration depth of
15-20 cm” was used in this series. In the obese patients, the authors “used an abdominal compression strap to facilitate positioning of the stone within the extended shock pathway.”
In the brochure of the manufacturer the technical information on the lithotripter used in this patient series list a focal distance of 135 mm and a focal Dimension 7.5 x 22 mm. (50 % isobar dim.)
How these data fit into the reported “penetration depth of 15-20 cm” or an “extended shock pathway” is not defined in the study.
There is no information if a lateral patient position with a shorter SSD was chosen as described by some authors for a more effective treatment of obese patients.
(Mezentsev VA. Extracorporeal shock wave lithotripsy in the treatment of renal pelvicalyceal stones in morbidly obese patients. Int Braz J Urol. 2005;31(2):105-10.
Karatzas A et al. Feasibility and efficacy of extracorporeal shock-wave lithotripsy using a new modified lateral position for the treatment of renal stones in obese patients. Urol Res. 2012; 40: 355-9).
The Skin-Stone-Distance (SSD) was not measured in this series. In a recently reviewed paper (Lee HY et al, 2015: Noncontrast computed tomography factors that predict the renal stone outcome after shock wave lithotripsy) a stone-to-surface distance (SSD) of >11.43 cm was a significant predictor for SWL failure.

The overall stone-free rate was 82% in group 1 and 67% in the obese patients group 2 (p=0.01).
A significantly smaller than 0.01 larger percentage of the obese group patients - 13 (32%) - required ureteroscopy for final stone clearance compared to the non-obese group: 8 (8%).

The obese patients obviously require more than just ESWL.

An electrohydraulic lithotripter (Multimed Classic; Elmed) with a “penetration depth of 15-20 cm” was used in this series. In the obese patients, the authors “used an abdominal compression strap to facilitate positioning of the stone within the extended shock pathway.” In the brochure of the manufacturer the technical information on the lithotripter used in this patient series list a focal distance of 135 mm and a focal Dimension 7.5 x 22 mm. (50 % isobar dim.) How these data fit into the reported “penetration depth of 15-20 cm” or an “extended shock pathway” is not defined in the study. There is no information if a lateral patient position with a shorter SSD was chosen as described by some authors for a more effective treatment of obese patients. (Mezentsev VA. Extracorporeal shock wave lithotripsy in the treatment of renal pelvicalyceal stones in morbidly obese patients. Int Braz J Urol. 2005;31(2):105-10. Karatzas A et al. Feasibility and efficacy of extracorporeal shock-wave lithotripsy using a new modified lateral position for the treatment of renal stones in obese patients. Urol Res. 2012; 40: 355-9). The Skin-Stone-Distance (SSD) was not measured in this series. In a recently reviewed paper (Lee HY et al, 2015: Noncontrast computed tomography factors that predict the renal stone outcome after shock wave lithotripsy) a stone-to-surface distance (SSD) of >11.43 cm was a significant predictor for SWL failure. The overall stone-free rate was 82% in group 1 and 67% in the obese patients group 2 (p=0.01). A significantly smaller than 0.01 larger percentage of the obese group patients - 13 (32%) - required ureteroscopy for final stone clearance compared to the non-obese group: 8 (8%). The obese patients obviously require more than just ESWL.
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