[Pain evaluation during extracorporeal lithotropsy]. / Évaluation de la douleur lors d'une séance de lithotripsie extra-corporelle.

OBJECTIVE: The aim of this study was to demonstrate the feasibility of extracorporeal lithotripsy using lithotripter Sortz MODULITH SLK(®) without analgesics. MATERIALS AND METHODS: An anonymous self-administered questionnaire was sent to 854 patients post-shock wave lithotripsy for urinary lithiasis. No patient had pain medication. The questionnaire included seven questions to assess the pain symptoms due to treatment. After 15 days, a reminder letter was sent. RESULTS: The response rate was 69% (591/854). The extracorporeal lithotripsy without analgesic treatment was generally well tolerated. About 70% of patients felt just a few or no pain and average pain assessment was 3.6/10 on VAS. The pain was often considered to be multifactorial, related to the treatment itself, the duration of the session and the position on the table. Anxiety seemed to play an equally important role in pain relief with an average VAS 4.5 against 2.9 for non-anxious patients. If a new session of extracorporeal lithotripsy was necessary, 53% of patients would require no pain medication. CONCLUSIONS: The extracorporeal lithotripsy could easily be done without systematic analgesics allowing for outpatient care. In contrast, anxiety seemed to be an important predictor of poor tolerance of sessions so the idea of a prophylactic anxiolytic treatment based on psychological profile of the patient should allow less aggressive and less costly management of urolithiasis.

[Extra corporeal shock wave lithotripsy in patients with body mass index over 35 Kg/m2]. / Lithotripsie extracorporelle et obésité avec un IMC supérieur à 35.

INTRODUCTION: The treatment of urinary stones in morbidly obese patients is associated with higher morbidity. Extra corporeal shock wave lithotripsy (ESWL) is one of the options to achieve urinary stone clearance with minimal morbidity of these patients. The purpose of this study was to evaluate the outcomes and efficiency of ESWL in patients with body mass index (BMI) upper 35 Kg/m(2). PATIENTS AND METHODS: We retrospectively reviewed the records of 98 patients with BMI more than 35 and urinary stones who were treated using ESWL from October 2002 to January 2008. Evaluation of efficiency was based on radiological examinations using abdominal radiography, echography or CT scan. It was mode during as consultation with the urologist surgeon four or six weeks after the last session. RESULTS: Ninety-eight patients, 53 men and 45 women, mean BMI 37.74 presented 133 urinary stones of mean size 10.38 mm. Their location was 83% renal, with 42.11% low caliceal. The number of ESWL is 219, without analgesics safe three under neuroleptanalgesics. Fifty-four cystoscopics stents have been pose (40.6%). The overall stone free was 56.3%, residual fragment of 37.5% and failure of 6.2%. The efficiency was bound to the BMI in a significant way. For the complications: five renal colics, three obstructive pyelonephritis with cystosccopic stent. CONCLUSION: We conclude that ESWL is an effective and mini invasive treatment, which can be proposed, in the first intention in the treatment of urinary stones to obese patients.