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Urolithiasis treatment in the obese and morbidly obese: A systematic review
4th EULIS Meeting Vienna, Austria
81
Urolithiasis treatment in the obese and morbidly obese: A systematic review Eur Urol Suppl 2017; 16(7);e2554
Corsaro A. , Seitz C. , Özsoy M. Comprehensive Cancer Center, Medical University of Vienna, Dept. of Urology, Vienna, Austria Introduction & Objectives: The prevalence of obesity and urolithiasis are both increasing worldwide. Although difficulties have been described when treating kidney stones with extracorporeal shock wave lithotripsy (SWL) in the obese population due to increased skin-to-stone-distance, whether obesity represents a limiting factor for percutaneous nephrolithotomy (PNL), ureteroscopy (URS) or flexible ureteroscopy (FURS) is still controversial. In this review we aim to assess the outcomes and safety of PNL, URS and FURS in the obese and morbidly obese population. Material & Methods: A comprehensive investigation of PubMed database was conducted in accordance with the PRISMA guidelines. Primary endpoints were SFR and complication rates. Secondary endpoints were length of hospital stay (LOS), re-treatment rates and mean surgery time (MST) which was defined as the duration of the urological procedure, excluding anesthesia. Body mass index (BMI) was classified in accordance to the World Health Organization (WHO): ideal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), obesity (>30.0 kg/m2), and morbidly obesity (>40.0 kg/m2). Results: 26 articles were eligible to include in this review. 12 studies investigating the impact of obesity on outcomes of PNL and 14 studies on URS/ FURS. For PNL Overall SFR was 81%. SFR’s in the ideal weight, obese and morbidly obese population were 82%, 81% and 74.2%, respectively. Overall complication rate was 20.3%. Complication rates in the ideal weight,obese and morbidly obese populations were 15.8% , 13.8% and 16.3%, respectively. For URS/FURS Overall SFR was calculated as 83.8%. SFR in the ideal weight, obese and morbidly obese population was calculated as 86%, 83.12% and 78.8%, respectively. Overall complications rates were 8.9%. Complications rates in the ideal weight,obese and morbidly obese population were 8.8% , 8.6% and 11% respectively. Conclusions: PNL, URS and FURS are safe and effective procedures in obese and morbidly obese patients provided distinct precautions are considered. No restriction should be addressed to patients’ BMI in the urolithiasis treatment decision making process.
Eur Urol Suppl 2017; 16(7);e2554
81
Urolithiasis treatment in the obese and morbidly obese: A systematic review Eur Urol Suppl 2017; 16(7);e2554
Corsaro A. , Seitz C. , Özsoy M. Comprehensive Cancer Center, Medical University of Vienna, Dept. of Urology, Vienna, Austria Introduction & Objectives: The prevalence of obesity and urolithiasis are both increasing worldwide. Although difficulties have been described when treating kidney stones with extracorporeal shock wave lithotripsy (SWL) in the obese population due to increased skin-to-stone-distance, whether obesity represents a limiting factor for percutaneous nephrolithotomy (PNL), ureteroscopy (URS) or flexible ureteroscopy (FURS) is still controversial. In this review we aim to assess the outcomes and safety of PNL, URS and FURS in the obese and morbidly obese population. Material & Methods: A comprehensive investigation of PubMed database was conducted in accordance with the PRISMA guidelines. Primary endpoints were SFR and complication rates. Secondary endpoints were length of hospital stay (LOS), re-treatment rates and mean surgery time (MST) which was defined as the duration of the urological procedure, excluding anesthesia. Body mass index (BMI) was classified in accordance to the World Health Organization (WHO): ideal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), obesity (>30.0 kg/m2), and morbidly obesity (>40.0 kg/m2). Results: 26 articles were eligible to include in this review. 12 studies investigating the impact of obesity on outcomes of PNL and 14 studies on URS/ FURS. For PNL Overall SFR was 81%. SFR’s in the ideal weight, obese and morbidly obese population were 82%, 81% and 74.2%, respectively. Overall complication rate was 20.3%. Complication rates in the ideal weight,obese and morbidly obese populations were 15.8% , 13.8% and 16.3%, respectively. For URS/FURS Overall SFR was calculated as 83.8%. SFR in the ideal weight, obese and morbidly obese population was calculated as 86%, 83.12% and 78.8%, respectively. Overall complications rates were 8.9%. Complications rates in the ideal weight,obese and morbidly obese population were 8.8% , 8.6% and 11% respectively. Conclusions: PNL, URS and FURS are safe and effective procedures in obese and morbidly obese patients provided distinct precautions are considered. No restriction should be addressed to patients’ BMI in the urolithiasis treatment decision making process.
Eur Urol Suppl 2017; 16(7);e2554