Singh NP. et al., 2020: Obesity and Kidney Stone Procedures

Thursday, 23 July 2020

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Nikhi P. Singh, BS, Carter J. Boyd, BS, William Poore, BS, Kyle Wood, MD, Dean G. Assimos, MD.
University of Alabama-Birmingham School of Medicine, Birmingham, AL.
Department of Urology, University of Alabama-Birmingham, Birmingham, AL.

Abstract

Obesity is a chronic disease that has increased in prevalence in the United States and is a risk factor for the development of nephrolithiasis. As with other medical conditions, obesity should be considered when optimizing surgical management and choosing kidney stone procedures for patients. In this review, we outline the various procedures available for treating stone disease and discuss any discrepancies in outcomes or complications for the obese cohort.
.Rev Urol. 2020;22(1):24-29.PMID: 32523468. FREE ARTICLE

Comments 1

Hans-Göran Tiselius on Wednesday, 29 July 2020 10:35

There is a well-recognized high risk of stone formation in obese patients. For selection of the most appropriate method for stone removal it is necessary to consider anatomical conditions together with the increased anaesthetic risk and technical/geometrical factors.

For SWL there are essentially two problems: Firstly, that the distance from the shockwave source to the stone might exceed the penetration depth of the system and secondly, that considerable losses of energy might occur during shockwave transmission. The first problem can be addressed either by using a device with extra long penetration depth or, as the authors mention, to use “blast-path” technique. Whereas the latter approach successfully was used with the Dornier HM3 device, there is limited information on this trick with modern small-focus electromagnetic lithotripters. I have used “blast path” in a couple of patients treated with the Storz Modulith lithotripter with some success when other treatment options were excluded. But for this trick it is important to correctly interpret the three-dimensional geometry and be aware of how the direction of the shockwave projects on the fluoroscopic screen.

It also might be possible to overcome the loss of energy by increasing the shockwave power, but also in this regard is there limited clinical experience.

Bottomline: For obese patients who can tolerate anaesthesia and who can be treated in supine position, URS/RIRS probably should be chosen as first line treatment.

Hans-Göran Tiselius

For SWL there are essentially two problems: Firstly, that the distance from the shockwave source to the stone might exceed the penetration depth of the system and secondly, that considerable losses of energy might occur during shockwave transmission. The first problem can be addressed either by using a device with extra long penetration depth or, as the authors mention, to use “blast-path” technique. Whereas the latter approach successfully was used with the Dornier HM3 device, there is limited information on this trick with modern small-focus electromagnetic lithotripters. I have used “blast path” in a couple of patients treated with the Storz Modulith lithotripter with some success when other treatment options were excluded. But for this trick it is important to correctly interpret the three-dimensional geometry and be aware of how the direction of the shockwave projects on the fluoroscopic screen.

It also might be possible to overcome the loss of energy by increasing the shockwave power, but also in this regard is there limited clinical experience.

Bottomline: For obese patients who can tolerate anaesthesia and who can be treated in supine position, URS/RIRS probably should be chosen as first line treatment.

Hans-Göran Tiselius

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