Laser Lithotripsy Safe for Obese Patients

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TORONTO—Ureteroscopic laser lithotripsy can be performed safely in obese patients, a new study has confirmed.

The study, which examined data from 266 patients treated with holmium:yttrium-aluminum-garnet laser lithotripsy at four centers across North America, revealed that patients' BMI did not affect stone clearance rates or the incidence of postoperative complications. The patients ranged in weight from 49 to 192 kg (108-423 lb).

Investigators led by Ben H. Chew, MD, MSc, Assistant Professor of Minimally Invasive Surgery and Kidney Stone Disease at the University of British Columbia in Vancouver, divided patients into three groups: normal-weight (BMI less than 25 kg/m2), overweight (BMI 25-30), and obese (BMI greater than 30).

The rates of postoperative stenting were similar in all three groups (75%, 78.3%, and 84.2% in normal-weight, overweight, and obese patients, respectively), as were the rates of postoperative complications—6.67%, 8.7%, and 4.6%, respectively.

Similar percentages of patients in the three groups were stone-free after lithotripsy: 77%, 79.7%, and 71.1%. A significantly larger proportion of obese patients (79.6%) required flexible ureteroscopy than overweight (58.8%) or normal-weight patients (48.8%).

Dr. Chew observed that while “obese patients are more likely to require flexible ureteroscopy, ureteroscopic laser lithotripsy is an effective and safe technique to treat urolithiasis in the overweight or obese patient.”

Findings were presented here at the Canadian Urological Association Annual Meeting.

Jerzy Gajewski, MD, Professor of Urology and Pharmacology at Dalhousie University in Halifax, Nova Scotia, agreed with Dr. Chew's conclusion, and observed: “Performing this procedure [ureteroscopic laser lithotripsy] is more challenging in these patients. However, the overall outcome seems to be the same as for nonobese individuals.”
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