Endoscopic and open stone surgery in morbidly obese patients

Management of urinary stone disease in the morbidly obese patient can be troublesome and problematic. We present 4 recent female patients with an average weight of 442 pounds and an average height of 5 feet 2 inches. The patients underwent a total of 8 open surgical or endoscopic procedures for partial or complete staghorn calculi. Complications encountered included inability to reach the stones with rigid or flexible ureteroscopes, inadvertent incision above the 10th rib for pyelolithotomy, intraoperative rhabdomyolysis during a flank incision, consecutive temporary renal failure and wound infection. We discuss the limitations of extracorporeal shock wave lithotripsy, retrograde endoscopic manipulation, percutaneous antegrade surgery and open surgical approaches. Such patients continue to represent diagnostic challenges and high risk therapeutic options.