title: A modification of standard percutaneous nephrolithotripsy technique for the morbidly obese patient.
abstract: OBJECTIVE
  Urolithiasis in the morbidly obese patient presents several unique challenges to the urologist, and its treatment often requires creativity and innovation. We present a new modification of standard percutaneous nephrolithotripsy (PNL) technique, which is very helpful in overcoming some of the problems that are encountered when performing PNL in this group of patients.
  
  
  METHODS
  We present 5 patients in whom this new technique has been used. Each had either failed prior extracorporeal shock-wave lithotripsy (ESWL) therapy or their size and abdominal girth precluded use of ESWL technology. All 5 patients underwent PNL. The radiographically measured skin-to-stone distances (determined by computed tomography or ultrasonography or both) exceeded the lengths of the standard percutaneous access sheaths and the 26 F rigid nephroscope. Thus larger and longer Amplatz access sheaths and a 30 F gynecologic laparoscope were used to reach the stones. Standard ultrasonic lithotripsy was then performed, and extralong bronchoscopic grasping forceps were used to remove stone fragments.
  
  
  RESULTS
  All 5 patients were rendered stone-free using this technique. There was no significant perioperative morbidity.
  
  
  CONCLUSIONS
  For this very challenging group of patients, the use of larger and longer access sheaths and the gynecologic laparoscope have been very effective additions to the urologists' armamentarium in the treatment of urolithiasis.
authors.affiliation: Department of Surgery (Urology), Georgetown University Medical Center, Washington, DC 20007, USA.
authors.forename: J G
authors.initials: JG
authors.lastname: Giblin
authors.forename: S
authors.initials: S
authors.lastname: Lossef
authors.forename: J J
authors.initials: JJ
authors.lastname: Pahira
mesh_terms: D000328:Adult; D000368:Aged; D004867:Equipment Design; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000150:complications / Q000628:therapy*; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation / Q000379:methods*; D009767:Obesity, Morbid / Q000150:complications*