ENDOSCOPIC MANAGEMENT OF UROLITHIASIS IN THE MORBIDLY OBESE PATIENT

A retrospective review of 48 consecutive morbidly obese patients with urolithiasis who were treated successfully by endoscopic modalities ov er 3.5 years was performed. Of the 73 endoscopic procedures, 48 were u reteroscopic laser lithotripsy (UL), 4 were ureteroscopic basket extra ction, and 21 were percutaneous nephrolithotripsy (PCNL). The patients ' weight ranged from 205 to 385 lbs. (average 286 lbs.). Their abdomin al girth ranged from 53 to 65 inches (average 59 inches). Twenty-six p atients had one procedure, eight patients had bilateral procedures, el even patients had two procedures, and three patients had three procedu res with utilization of either multiple ureteroscopic treatments or th e combination of percutaneous and ureteroscopic techniques. The stone- free rate after one procedure was 77.8% for UL and 60% for PCNL. The s tone-free rate after planned repeat procedures was 97% for UL/UL and 8 9% for PCNL/UL. There were two minor complications. Forty-eight proced ures mere performed on an outpatient basis, and the remaining 25 proce dures necessitated hospital admission (average 3.6 days). Morbidly obe se patients with urolithiasis who are unable to have SWL because of th eir body weight and abdominal girth can be treated successfully with U L, ureteroscopic basket extraction, and PCNL with efficacy comparable to that in patients of normal weight and with minimal morbidity. Many renal calculi were treated with UL alone with a high success rate.