title: 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.
abstract: OBJECTIVE
  The aim of the study was to analyze results and morbidity after flexible ureterorenoscopy in patients with a body mass index (BMI) >30 kg/m(2) and to compare with results obtained in a large cohort of nonobese patients.
  
  
  METHODS
  We conducted a retrospective study including all flexible ureterorenoscopy performed for stone retrieval in our institution between January 2004 and December 2008. During the study period, 224 procedures were performed, of which 18 had to be excluded because of missing BMI data. Thus, a total of 206 procedures were included in the final analysis (34 in 29 obese patients, 172 in 149 nonobese patients). Characteristics of the patients (age, BMI, previous treatment), stones (nature, location, number), and procedures (operating time, morbidity, outcome) were analyzed. Success was defined as clear imaging (completely stone free) on renal tomography and ultrasonography at 1, 3, and 6 months follow-up.
  
  
  RESULTS
  Mean BMI was 34±0.6 kg/m(2) in obese patients (OP) and 24±0.2 kg/m(2) in nonobese patients (NOP). Mean stone size, location, and composition were not significantly different between groups. Operative time was also similar in OP and NOP (102.5±6.1 min vs 103±3.4 min, P=NS). The rate of minor complications (fever, hematuria, flank pain) was similar in OP (11.8%) and NOP (11.4%). No major complication necessitating prolonged hospital stay or new surgical procedure was observed. The overall stone-free rate was not significantly different between OP (79.4%) and NOP (70%).
  
  
  CONCLUSIONS
  Flexible ureterorenoscopy is an appropriate treatment for use in obese patients and achieves excellent stone-free rates with low morbidity.
authors.affiliation: Dept. of Urology and Renal Transplantation, University Hospital Saint-Jacques, Besançon, France.
authors.forename: Gregory
authors.initials: G
authors.lastname: Delorme
authors.forename: Yann Nguyen
authors.initials: YN
authors.lastname: Huu
authors.forename: Julien
authors.initials: J
authors.lastname: Lillaz
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bernardini
authors.forename: Eric
authors.initials: E
authors.lastname: Chabannes
authors.forename: Guillaume
authors.initials: G
authors.lastname: Guichard
authors.forename: Hugues
authors.initials: H
authors.lastname: Bittard
authors.forename: François
authors.initials: F
authors.lastname: Kleinclauss
mesh_terms: D015992:Body Mass Index; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D053844:Lasers, Solid-State / Q000009:adverse effects* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000379:methods*