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ESWL Kidney - Urethral Treatment on Obese Patients


Dr. Ruben Munoz, Dr. Pierre P. Tirolien, Clinique Saint-Pierre, Guadeloupe, France
XIV National Conference of Lithiasis and Urinary Endoscopy,
January 28-29-30, 2002, Siguenza (Guadalajara, SPAIN)

100 treated cases with NOVA ULTIMA Extra Corporal Lithotripter (Direx Medical Systems)

Introduction

Obesity is considered as an important risk factor for illnesses such as the arterial hypertension, diabetes, coronary and metabolic disorders, etc., increasing considerably the surgical risk. By means of ESWL we treated an interesting number of patients with the purpose to avoid the prolonged and after surgery complications, due patients volume.
The patients had been selected by use of the Index of Mass Corporal (IMC) of Quetelet:  

imc_143   25 < IMC < 27  27 < IMC < 30  IMC > 30
medium overweight 
important overweight   obese 

Material and Methods

From April 2000 to August 2001 we have treated 100 obese patients with kidney and urethral stones, using a Nova Ultima Extra Corporal Lithotripter from Direx Medical Systems.
A neuroleptanalgesic had been done to a 92% of the patients and narconeuroleptanalgesic to an 8% of them. The 85% stayed 24 hours in the hospital and the 15% were ambulatories. Treated patients: 63 men with more than 90 kg weight (90-141) and 37 women with more than 80 kg weight (80-118). Age average: 42 years old (20-72). Treatment on: 77 kidney stones, 12 pelvic stones, and 7 urethral stones. An 80% had been localized by means of an ultrasound scan (more than 50% in lateral posture) and 20% by means of a fluoroscopic. The stone size average was 12 mm. In a 62% of cases the localization was easy and in a 38% it was difficult, principally the urethral and pelvic stones. All the patients received 3000 shoots at KV 21-22, in a high energy with a time average of 35 minutes every session.

 novaua_106  novaub_111  novauc_97  novaud_92  novaux_97

Lateral posture
Ultrasound scanner
Localization

Dorsal posture 
Fluoroscopy
Localization
Lateral posture
Ultrasound scanner
Localization
Localization
Fluoroscopy
Localization
Lateral posture
Ultrasound scanner
Localization

The lateral posture permits an excellent ultrasound scans image avoiding abdominal and suprarenal folds and also an improvement to the skin contact with the membrane.
Results: The results in a three months period had been:

novaue_236_01
The best results obtained were with the pelvic and lumbar urethral stones (82%)

 

We carried out a supplementary session on 24 patients, two sessions on 6 patients and three sessions on 4 patients (voluminous stones)

 

 novauf_205  novaug_205  novauh_203
Lower calix (bef.and aft.lithotr
 
Lumbar urethral UIV After lithotripsy
 
Lower calix (bef.and aft.lithotr.)
 

Discussion

For the kidney and urethral stones treatment on obese patients the lithotripter features are very important and the operator experience too. The knowledge and application of the localization systems permits to the specialist to obtain a better percentage of stone free. These techniques are important for these patients due to the posture on the table, which is fundamental to obtain a good result (50% in lateral posture with ultrasound scan).

Conclusion

The indication of using ESWL on obese patients is a good choice but we always have to be respectful with the criteria of selection. The percentage of stone free in a three-month period has been satisfactory and the complications are similar to the ones published by other authors.





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