munoz
ESWL KIDNEY - URETHRAL TREATMENT ON OBESE
PATIENTS
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100 treated cases with NOVA ULTIMA Extra Corporal
Lithotripter
(Direx Medical Systems)
Dr. Ruben Munoz, Dr. Pierre P. Tirolien
Clinique Saint-Pierre, Guadeloupe, France
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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:
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25 < IMC < 27
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27 < IMC < 30
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IMC > 30
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medium overweight
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important overweight
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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.
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Lateral posture
Ultrasound scanner
Localization
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Dorsal posture
Fluoroscopy
Localization
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Lateral posture
Ultrasound scanner
Localization
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Dorsal posture
Fluoroscopy
Localization
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Lateral posture
Ultrasound scan
Localization
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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:
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)
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Lower calix (bef.and aft.lithotr
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Lumbar urethral UIV After lithotripsy
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Lower calix (bef.and aft.lithotr.)
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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.
XIV National Conference of Lithiasis and Urinary Endoscopy,
January 28-29-30, 2002, Sig?enza (Guadalajara, SPAIN)
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ruben
The unique voluminous and staghorn stones treated with the
Nova Ultima (Direx).80 cases.
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Dr. Ruben D. Munoz Montastruc. Dr. Pierre P
Tirolien. Dr. Steve Belhamou.
Dr Mogues Desta. Dr Remy Grimberg.
Clinique Saint Pierre.Guadeloupe.Francia
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Introduction:
The voluminous and staghorn stones in the present time are representing a reduced percentage within the
kidney stone disease. We demonstrate the obtained results in 80 stones treated with ESWL in the last years.
Material and methods:
It has been treated 69 patients for a total of 80 stones. 10 patients had bilateral unique voluminous
stones and 2 patients had bilateral staghorn stones. All the cases were treated with neuroleptanalgesic.
The age average was of 46 years old (20-82). Weight average: 74 kg (32-141). 26 patients had stone records
and 15 suffered a stone surgery. The size of the unique stones was of 2,3 cm. The size of 7 complete
staghorn stones was of more than 4 cm. And the size of 8 partial staghorn stones was of less than 4
cm.
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Stones localization:
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Results: fragmentation 94%
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Stone Free < 4mm between 4 y 10mm >10mm Failures
82% good result 12%
partial fragmentation 6%l |
The average of re-treatments was of 2.15 sessions.
The most important complication to emphasize was a sub capsular hematoma in a 20-year-old patient of 100 kg with a voluminous pelvic stone. The hematoma was discovered after-lithtoripsy through the ultrasound scan and the progress was favorable without operate needs.
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Conclusion:
Taking the obtained results, we consider that the extra corporeal lithotripsy by shockwaves is
one of the choice techniques of low risk for these stones treatment. We stand out the importance
of placing the double probe J in all the cases for avoid the possible kidney colic and/or an infection
by urethral obstruction.
It is essential important to take some criterions of selection of the cases to obtain better results.
LXVII Congreso Nacional de Urologia.
MURCIA, 4 - 8 de Mayo, 2002. ESPANA
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