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RIRS is equally efficient in patients with different BMI scores

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The objective of the study was to ascertain whether flexible ureteroscopy with holmium laser lithotripsy and/or extraction of stone fragments is as effective in obese patients as in non-obese patients. The patients were divided into four groups (group 1: normal weight = 79 procedures, group 2: overweight = 123 procedures, group 3: obese = 87 procedures, and group 4: morbidly obese = 20 procedures) according to BMI cohorts. Patient charts were retrospectively reviewed and relevant data collected. A total of 309 operations were included in the present study. The overall mean ± SD (range) age was 41 ± 12 years (18–82), BMI 29 ± 6 kg/m2 (18–52), operative time 64 ± 29 min (20–200), hospital stay 25 ± 11 h (4–168), stone number 3 ± 2 (1–15), stone burden 21 ± 14 mm (4–98), and internal stenting time 26 ± 8 days (2–60). Mean stone size was 10 ± 6, 9 ± 5, 11 ± 8, and 11 ± 8 mm for groups 1 through 4, respectively. There were no differences among groups regarding patients and stone characteristics, and perioperative parameters including patient age, operative time, hospital stay, and complications. Overall SFRs were similar between groups (81, 87, 87.4, and 85 %, respectively; χ 2=3.304, p=0.770) as were the complication rates (12–16 %). Our contemporary Retrograde Intrarenal Surgery (RIRS) series showed that operative times, hospital stays, ancillary equipment use (internal stent, basket, etc.), SFRs, and complication rates were independent of BMI. Therefore, RIRS can be performed as efficiently and efficaciously in obese patients as in non-obese patients.

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  1. Calvert RC, Burgess NA (2005) Urolithiasis and obesity: metabolic and technical considerations. Curr Opin Urol 15:113–117

    Article  PubMed  Google Scholar 

  2. Stevens J, Cai J, Pamuk ER, Williamson DF, Thun MJ, Wood JL (1998) The effect of age on the association between body-mass index and mortality. N Engl J Med 338:1–7

    Article  CAS  PubMed  Google Scholar 

  3. Asplin JR (2009) Obesity and urolithiasis. Adv Chronic Kidney Dis 16:11–20

    Article  PubMed  Google Scholar 

  4. Harris MI, Flegal KM, Cowie CC, Eberhardt MS, Goldstein DE, Little RR, Wiedmeyer HM, Byrd-Holt DD (1998) Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in US adults: the Third National Health and Nutrition Examination Survey, 1988–1994. Diabetes Care 21:518–524

    Article  CAS  PubMed  Google Scholar 

  5. Türk C, Knoll T, Petrik A, Sarica K, Straub M, Seitz C(2014): Guidelines on Urolithiasis. EAU.

  6. Osman MM, Alfano Y, Kamp S, Haecker A, Alken P, Michel MS, Knoll T (2005) 5-year-follow-up of patients with clinically insignificant residual fragments after extracorporeal shockwave lithotripsy. Eur Urol 47:860–864

    Article  PubMed  Google Scholar 

  7. Dindo D, Demartines N, Clavien PA (2004) The Clavien-Dindo classification of surgical complications. Ann Surg 244:931–937

    Google Scholar 

  8. Traxer O, Thomas A (2013) Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol 189(2):580–584

    Article  PubMed  Google Scholar 

  9. Andreoni C, Afane J, Olweny E, Clayman RV (2001) Flexible ureteroscopic lithotripsy: first-line therapy for proximal ureteral and renal calculi in the morbidly obese and superobese patient. J Endourol 15(5):493–498

    Article  CAS  PubMed  Google Scholar 

  10. Scales CD Jr, Smith AC, Hanley JM, Saigal CS (2012) Prevalence of kidney stones in the United States. Eur Urol 62:160–165

    Article  PubMed Central  PubMed  Google Scholar 

  11. Herrara MF, Lozano-Salazar RR, Gonzales-Barranco J, Rull JA (1999) Diseases and problems secondary to massive obesity. Eur J Gastroenterol Hepatol 11:63

    Article  CAS  PubMed  Google Scholar 

  12. Galvin DJ, Pearle MS (2006) The contemporary management of renal and ureteric calculi. BJU Int 98:1283–1288

    Article  PubMed  Google Scholar 

  13. Robert M, A’Ch S, Lanfrey P, Guiter J, Navratil H (1999) Piezoelectric shockwave lithotripsy of urinary calculi: comparative study of stone depth in kidney and ureter treatments. J Endourol 13:699–703

    Article  CAS  PubMed  Google Scholar 

  14. Munoz RD, Tirolien PP, Belhamou S, Desta M, Grimberg R, Dulys P, Chevallier H (2003) Treatment of reno-ureteral lithiasis with ESWL in obese patients. Apropos of 150 patients. Arch Esp Urol 56:933–938

    PubMed  Google Scholar 

  15. Bagrodia A, Gupta A, Raman JD, Bensalah K, Pearle MS, Lotan Y (2008) Impact of body mass index on cost and clinical outcomes after percutaneous nephrostolithotomy. Urology 72(4):756–760

    Article  PubMed  Google Scholar 

  16. Carson CC III, Danneberger JE, Weinerth JL (1988) Percutaneous lithotripsy in morbid obesity. J Urol 139:243–245

    PubMed  Google Scholar 

  17. Fuller A, Razvi H, Denstedt JD, Nott L, Pearle M, Cauda F, Bolton D, Celia A, de la Rosette J (2012) The CROES percutaneous nephrolithotomy global study: the influence of body mass index on outcome. J Urol 188:138–144

    Article  PubMed  Google Scholar 

  18. Breda A, Ogunyemi O, Leppert JT, Schulam PG (2009) Flexible ureteroscopy and laser lithotripsy for multiple unilateral intrarenal stones. Eur Urol 55:1190–1196

    Article  PubMed  Google Scholar 

  19. Chew BH, Zavaglia B, Paterson RF, Teichman JM, Lange D, Zappavigna C, Matlaga BR, Nunez-Nateras R, Bruhn A, Altamar HO, Humphreys MR, Shah O, Miller NL (2013) A multicenter comparison of the safety and effectiveness of ureteroscopic laser lithotripsy in obese and normal weight patients. J Endourol 27(6):710–714

    Article  PubMed  Google Scholar 

  20. Best SL, Nakada SY (2011) Flexible ureteroscopy is effective for proximal ureteral stones in both obese and non obese patients: a two-year, single-surgeon experience. Urology 77:36–39

    Article  PubMed  Google Scholar 

  21. Caskurlu T, Atis G, Arikan O, Pelit ES, Kilic M, Gurbuz C (2013) The impact of body mass index on the outcomes of retrograde intrarenal stone surgery. Urology 81(3):517–521

    Article  PubMed  Google Scholar 

  22. Delorme G, Huu YN, Lillaz J, Bernardini S, Chabannes E, Guichard G, Bittard H, Kleinclauss F (2012) Ureterorenoscopy with holmium-yttrium-aluminum-garnet fragmentation is a safe and efficient technique for stone treatment in patients with a body mass index superior to 30 kg/m2. J Endourol 26(3):239–243

    Article  PubMed  Google Scholar 

  23. Chotikawanich E, Korman E, Monga M (2011) Complications of stone baskets: 14-year review of the manufacturer and user facility device experience database. J Urol 185:179

    Article  PubMed  Google Scholar 

  24. Parker BD, Frederick RW, Reilly TP, Lowry PS, Bird ET (2004) Efficiency and cost of treating proximal ureteral stones: shock wave lithotripsy versus ureteroscopy plus holmium: yttrium-aluminum-garnet laser. Urology 64:1102–1106

    Article  PubMed  Google Scholar 

  25. Aboumarzouk OM, Somani B, Monga M (2012) Safety and efficacy of ureteroscopic lithotripsy for stone disease in obese patients: a systematic review of the literature. BJU Int 110:374–380

    Article  Google Scholar 

  26. Nabi G, Cook J, N’Dow J, McClinton S (2007) Outcomes of stenting after uncomplicated ureteroscopy: systematic review and meta-analysis. BMJ 334:572

    Article  PubMed Central  PubMed  Google Scholar 

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Correspondence to Erdal Alkan.

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Alkan, E., Arpali, E., Ozkanli, A.O. et al. RIRS is equally efficient in patients with different BMI scores. Urolithiasis 43, 243–248 (2015).

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