ABSTRACT
CONTEXT: Urolithiasis and obesity are now public health problems with an increased incidence worldwide. Management of urolithiasis in patients with morbid obesity is usually associated with higher morbidity and mortality compared to non-obese patients. ESWL is a nonsurgical procedure for the treatment of lithiasis. In obese patients the ESWL efficacy is influenced by the skin-to-stone distance or poorer detection of the calculus because of the fatty tissue. OBJECTIVE: To highlight the overweight or obese lithiasic patient profile that could be best treated by ESWL. SUBJECTS AND METHODS: We evaluated ESWL results in 1393 patients with kidney or ureteral stones between 5 and 20 mm. They were divided into 4 groups according to the BMI: Group A-overweight (BMI=25-30 kg/m2); Group B-grade I obesity (BMI=30-35 kg/m2); Group C-grade II obesity (BMI=35-40 kg/m2) and a control group of normal weight (BMI=18-25 kg/m2). RESULTS: Patients with a higher BMI required a greater number of ESWL sessions. A statistically significant greater number of patients with a waist circumference of >102 cm required more than 2 SWL sessions (p=0.007). Location of the stones in the pelvic ureter had the highest rate of success for obese patients (p=0.00001). The ESWL success rate in overweight and obese patients can be negatively influenced by BMI, abdominal circumference over 102 cm, and hardness of calculi reflected in the radiopacity on KUB. CONCLUSIONS: In patients with grade II obesity, pyelocaliceal calculus and increased hardness, other urological alternatives to lithiasis should be considered from the beginning.
ABSTRACT
INTRODUCTION: Percutaneous nephrolithotomy (PCNL) represents a safe and efficient procedure in the surgical management of renal lithiasis. Nevertheless, surgeons have to face specific complications during and after the procedure, hemorrhage being one of the most common. In most cases the injuries are self-limited and do not need a surgical intervention. Renal arteriography with selective angiographic embolization is needed in patients with massive hemorrhage or continuous hematuria. Our objective was to evaluate the effectiveness of percutaneous transarterial embolization for the treatment of renal arterial post-PCNL bleeding. MATERIAL AND METHOD: This retrospective study was performed between March 2007 and October 2012 and included 22 patients who had undergone renal embolization due to significant post-PCNL renal artery bleeding. The site, number, and type of bleeding lesions, and the result of the embolization procedure were recorded. We report on the incidence, treatment, radiological and clinical results of these serious vascular injuries at our institution. RESULTS: Our study has included a large group of patients, the 95.45% angiographic success rate confirming that percutaneous transcatheter embolization is a valuable treatment for most renal vascular injuries. Renal angiography revealed pseudoaneurysm in 15 patients, arteriovenous fistula in 5 and arterial laceration in 2 patients. Significant risk factors on univariate analysis for severe hematuria requiring superselective angiography were multiple staghorn calculi, upper calix puncture and history of pyelonephritis. The severity of the hematuria after PCNL is influenced by many factors, including mean stone size and mean operative time and is correlated with duration of hospitalization and mean hemoglobin drop. CONCLUSIONS: Percutaneous transarterial embolization of the injured vessel is an effective, minimally invasive and relatively easy procedure in experienced centers, with high rate of success and immediate benefits, thus saving the patient from the morbidity that results from severe renal bleeding.
