Ureteroscopy pp 399-405 | Cite as

Medical Comorbidities: Anticoagulation and Obesity

  • Elias S. HyamsEmail author
  • Brian R. Matlaga
Part of the Current Clinical Urology book series (CCU)


Retrograde ureterorenoscopy (URS) is a standard treatment approach for renal and ureteral stones, as well as for other upper tract pathology like ureteral stricture disease and transitional cell carcinoma. Obese patients present unique challenges for treatment of stone disease in particular, as shock wave lithotripsy (SWL) has a higher risk of failure in these patients, and percutaneous nephrolithotomy (PNL) may present technical challenges based on large body habitus. URS, then, may be the preferred approach in patients with significant obesity, though there may be anesthesia and surgical challenges to this procedure as well. URS may also be the treatment of choice in patients with bleeding disorders, or those who are anticoagulated, based on bleeding risks associated with alternative modalities (e.g., SWL and PNL). Refinements in ureteroscope and laser technology have enabled safe therapeutic interventions in this population despite their propensity for bleeding. Care to minimize trauma to the upper tract during these interventions is necessary to ensure treatment safety and efficacy.


Obstructive Sleep Apnea Obese Patient Shock Wave Lithotripsy Stone Disease Stone Size 
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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Brady Urological Institute, Johns Hopkins Medical InstitutionsBaltimoreUSA

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