OBESITY: A DELICATE ISSUE CHOOSING THE ESWL TREATMENT FOR PATIENTS WITH KIDNEY AND URETERAL STONES?

Area of Science:

• Urology
• Nephrology
• Public Health

Background:

• Urolithiasis and obesity present significant global health challenges.
• Managing kidney stones in obese patients often leads to increased complications.
• Extracorporeal Shock Wave Lithotripsy (ESWL) is a non-surgical option, but its effectiveness in obese patients is affected by body composition.

Purpose of the Study:

• To identify characteristics of overweight and obese patients with kidney stones who are suitable candidates for ESWL.
• To evaluate the impact of body mass index (BMI) and other factors on ESWL outcomes in patients with urolithiasis.

Main Methods:

• A study involving 1393 patients with kidney or ureteral stones (5-20 mm).
• Patients were categorized into four groups based on BMI: normal weight, overweight, grade I obesity, and grade II obesity.
• ESWL outcomes were analyzed in relation to BMI, waist circumference, stone location, and calculus hardness.

Main Results:

• Higher BMI correlated with an increased number of ESWL sessions required.
• Patients with a waist circumference >102 cm significantly more often needed over two SWL sessions (p=0.007).
• Stone location in the pelvic ureter showed the highest success rate in obese patients (p=0.00001).
• ESWL success in overweight and obese patients was negatively influenced by BMI, abdominal circumference >102 cm, and calculus hardness.

Conclusions:

• For patients with grade II obesity, pyelocaliceal stones, and increased calculus hardness, alternative urological treatments should be considered early.
• Careful patient selection is crucial for optimizing ESWL outcomes in overweight and obese individuals.