Muñoz RD, Tirolien PP, Belhamou S, Desta M, Grimberg R, Dulys P, Chevallier H. [Treatment of reno-ureteral lithiasis with ESWL in obese patients. Apropos of 150 patients].
ARCH ESP UROL 2003;
56:933-8. [PMID:
14639849]
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Abstract
OBJECTIVES
Obesity is considered a significant risk factor for diseases such as hypertension, diabetes, coronary artery disease, and metabolic diseases, increasing considerably the risk for surgery. We have treated with ESWL a significant number of patients with the aim of avoiding operations which could be long and have associated complications due to the patient's condition.
METHODS
From April 2000 to May 2002 we treated 150 obese patients with kidney and/or ureteral stones using a Nova Ultima lithotripter. 94% of the patients were treated with a neuroleptoanalgesic drug, and 6% of the cases required narcotic-neuroleptoanalgesia. 85% of the cases were admitted for 24 hours, and 15% were outpatient. 94 males and 56 females who weighted more than 90 kg (91-141 kg) and more than 80 kg (80-127 kg) respectively were treated. Mean age was 41 years (range 20-72). 134 stones were located in the kidney, 27 in the pelvis and 16 in the ureter (25 patients presented bilateral lithiasis and 2 one ureteral stone and one homolateral kidney stone). Mean stone size was 12 mm. Stone track down was easy in 64% of the cases and difficult in 36%, mainly ureteral and pelvic stones. All patients received 3,000 shock waves at 21-22 KV and high energy with an average time per session of 35 minutes. Ultrasound tracking was preferred in 80% of the patients.
RESULTS
Results at three months were: 72% stone-free, 9% < 4 mm, 14% > = 4 mm, and 5% failures. Best results were obtained in pelvic and lumbar ureter stones (88%). Mean retreatment was 1.6, with one additional session in 34 patients, two sessions in 8, and three sessions in 5.
CONCLUSIONS
In the treatment of urolithiasis in obese patients, lithotriptor machine characteristics and operator experience are very important. The knowledge and the application of stone tracking systems allow the urologist to obtain a higher percentage of stone free patients. These techniques are important in these patients because positioning is key to obtain a good result. The indication of ESWL in obese patients is a good choice but selection criteria should be respected. The percentage of stone free patients at three months has been satisfactory and complications are similar to those published by other authors.
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