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

Alexandre Pompeo,Wilson R Molina,David Sehrt,Fernando J Kim,Cesar Juliano

doi:10.1590/s1677-5538.ibju.2013.05.13

Abstract

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. 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. 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. 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.

Highlights

The 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
According to the World Health Organization guidelines, a body mass index (BMI) of 18.5 to 25 kg/m2 is considered normal, overweight is a BMI of 25 to ibju | Intracorporeal lithotripsy of upper tract stones is not affected by BMI and skin-to-stone distance (SSD)
Ureteral stones had a higher SSD than renal stones (13.0 ± 2.6cm and 10.4 ± 2.8 cm, respectively) and was statistically significant (p < 0.001)

Summary

Introduction

The 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. Data from the National Center for Health Statistics (2009-2010) 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/m2 is considered normal, overweight is a BMI of 25 to ibju | Intracorporeal lithotripsy of upper tract stones is not affected by BMI and skin-to-stone distance (SSD)

Objectives

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Conclusion