Extracorporeal shock wave lithotripsy in the treatment of renal pelvicalyceal stones in morbidly obese patients

• Unenhanced CT is now widely used to assess ureteric calculi. • The same CT protocol can provide measurements of abdominal fat distribution. • Ureteric calculi are usually treated by shock wave lithotripsy (SWL). • Greater intra-abdominal fat stores are generally associated with poorer SWL results.

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“…In recent years, it has been suggested that central obesity might play an important role in the success rate of SWL [7,8].…”

Section: Introductionmentioning

confidence: 99%

Abdominal fat distribution on computed tomography predicts ureteric calculus fragmentation by shock wave lithotripsy

et al. 2012

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“…On the other hand, ESWL plays an important role in the treatment of nephrolithiasis in obese patients, since it is a safe procedure without the need for anesthesia [11,21]. However, the ESWL efficacy in obese patients is not as high as in non-overweight patients, mainly due to poorer identification of the stone, increased skin-to-stone distance and the shock-wave attenuation by body fat, which has some effect on the efficiency of stone fragmentation [7,11,17,19,21].…”

Section: Discussionmentioning

confidence: 99%

“…However, the ESWL efficacy in obese patients is not as high as in non-overweight patients, mainly due to poorer identification of the stone, increased skin-to-stone distance and the shock-wave attenuation by body fat, which has some effect on the efficiency of stone fragmentation [7,11,17,19,21].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, abdominal compression straps were used in 24 patients to overcome difficulties in positioning. The overall stone-free rate of 73% was achieved and the mean number of treatments per patient was 2.1 [11]. It is evident that a comparison between different kinds of lithotripters is not an easy task, since there are lots of differences in the way they work.…”

Section: Discussionmentioning

confidence: 99%

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Feasibility and efficacy of extracorporeal shock-wave lithotripsy using a new modified lateral position for the treatment of renal stones in obese patients

et al. 2011

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The aim of our study was to evaluate the efficacy and safety of ESWL using a modified lateral position in obese patients with renal stones. Nineteen obese patients with renal stones were enrolled (group A). The mean stone diameter was 1.3 cm (0.7-1.9 cm). The mean BMI was 35.1 kg/m² (31-41 kg/m²). Patients were placed in the lateral position, with the energy source facing their body posteriorly and the site where the stone was located in direct contact with the water cushion. Success rate (defined as the percentage of patients who were stone-free or with insignificant fragments after 3 months), mean number of ESWL sessions, mean duration of ESWL session and complications were recorded. The results were compared with those of 17 obese patients (Group B) with similar baseline characteristics treated in the standard supine position. All ESWLs were performed using the Dornier lithotripter SII. Both success rate (68.4 vs. 64.7% for groups A and B, respectively) and mean number of sessions (2.2 vs. 2.6) did not differ significantly between the two groups (p = 0.5). Interestingly, the time required to complete ESWL was significantly shorter for group A patients (56 min) compared to group B (73 min) (p = 0.001). No severe complications (including hematoma, pyelonephritis) were recorded. Our data indicate that ESWL in the modified lateral position for renal calculi in obese patients seems to be feasible and safe. In addition, it is faster than in the supine position since it overcomes technical difficulties. Further studies with a large number of patients are required to support our findings.

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“…As the intracorporeal portion of distance to the focal point increases, stone fragmentation and clearance is reduced. Other important drawback is that other variables that have been related to outcome, such as stone location and composition (9,10), and data obtained from a NCCT such as radiographic density measured in Hounsfield Units (HU) (11-13), anatomical findings and SSD (4,14) were not included in the analysis. A special consideration should be made regarding SSD, a test addresses the same issue as the Lithotripsy table height.…”

Section: Discussionmentioning

confidence: 99%

The lithotripsy table height: a novel predictor of outcome in shockwave lithotripsy

et al. 2011

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Background: Outcome of Extracorporeal Shockwave Lithotripsy (SWL) is determined by physical factors that affect stone fragmentation and clearance. Purpose: To evaluate the predictive value of the Lithotripsy Table Height (LTH) in SWL outcome. Lithotripsy Table Height (LTH) is a variable that represents skin to therapy head distance, and it is proportional to the energy that reaches the stone. Materials and Methods: A prospective study enrolled patients undergoing SWL for radiopaque urinary stones. All procedures were performed using a Modulith SLX (Karl Storz, Germany) Lithotripter. Patient weight, height and age; stone location and size; number of shock waves delivered, and LTH were recorded. One month post-procedure a KUB was obtained. Logistic regression analysis was used to evaluate the effects of these variables on stone-free outcome. A ROC curve was plotted. Results: Fifty-six patients were enrolled. After one month follow-up, overall success rate (Stone Free) was 83.9% (n = 47). LTH was the only independent predictor of outcome in both univariate and multivariate analysis (p = 0.029). Stone size (p = 0.45) and BMI (p = 0.32) were not significant. In the ROC curve, LTH showed an Area under the Curve = 0.791. Patients with LTH < 218 (n = 8) had relative risk of residual stones = 7.5, odds Ratio: 6.6 (Stone free rate 37.5% vs. 91.5%). Conclusion: LTH appears to be an independent predictor of SWL outcome. High success rates can be expected if LTH > 218. Patients with lower LTH had a less effective therapy, therefore, worse stone fragmentation and clearance. These findings may help improve patient selection for SWL therapy.

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Extracorporeal shock wave lithotripsy in the treatment of renal pelvicalyceal stones in morbidly obese patients

Cited by 34 publications

References 10 publications

Abdominal fat distribution on computed tomography predicts ureteric calculus fragmentation by shock wave lithotripsy

Abdominal fat distribution on computed tomography predicts ureteric calculus fragmentation by shock wave lithotripsy

Feasibility and efficacy of extracorporeal shock-wave lithotripsy using a new modified lateral position for the treatment of renal stones in obese patients

The lithotripsy table height: a novel predictor of outcome in shockwave lithotripsy

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