title: Treatment of urolithiasis in the morbidly obese.
abstract: BACKGROUND
  Morbidly obese patients with urolithiasis present a therapeutic and diagnostic challenge to the Urologist. Management is reported and potential difficulties discussed.
  
  
  METHODS
  Morbidly obese patients (body mass index > or = 40kg/m2) with stone disease were identified by retrospective review. Stone load was calculated and treatment modalities noted.
  
  
  RESULTS
  18 renal units (kidneys) were treated in 17 patients. Of these, 2 required no treatment, 2 had open procedures, and 15 were treated with flexible ureteroscopy. Mean stone burden in patients treated with flexible ureteroscopy was 18 mm, but 8 patients had stone loads >15 mm and in these patients mean stone burden was 23 mm. All were successfully treated or rendered asymptomatic. There were no major complications.
  
  
  CONCLUSIONS
  Obesity is increasingly prevalent and associated with a high incidence of co-morbidity and complications. Imaging can be difficult and treatment options are limited. Flexible ureteroscopy has proven to be the most successful treatment option, and can avoid the need for more invasive procedures. Furthermore, stone loads greater than normally acceptable can be successfully undertaken in these patients, and should be attempted due to problems associated with other techniques.
authors.affiliation: Department of Urology, 1st Floor Thomas Guy House, Guy's Hospital, St Thomas Street, London SE1 9RT, UK. matthew.bultitude@gstt.sthames.nhs.uk
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Bultitude
authors.forename: Richard C
authors.initials: RC
authors.lastname: Tiptaft
authors.forename: Prokar
authors.initials: P
authors.lastname: Dasgupta
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Glass
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications*; D012189:Retrospective Studies; D018666:Ureteroscopy / Q000379:methods*; D014545:Urinary Calculi / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D013520:Urologic Surgical Procedures / Q000379:methods