Bultitude Matthew F, Tiptaft Richard C, Dasgupta Prokar, Glass Jonathan M
Department of Urology, 1st Floor Thomas Guy House, Guy's Hospital, St Thomas Street, London SE1 9RT, UK.
Obes Surg. 2004 Mar;14(3):300-4. doi: 10.1381/096089204322917783.
Morbidly obese patients with urolithiasis present a therapeutic and diagnostic challenge to the Urologist. Management is reported and potential difficulties discussed.
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.
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.
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.
患有尿石症的病态肥胖患者给泌尿外科医生带来了治疗和诊断方面的挑战。本文报告了相关治疗情况并讨论了潜在困难。
通过回顾性研究确定患有结石病的病态肥胖患者（体重指数≥40kg/m²）。计算结石负荷并记录治疗方式。
17例患者共18个肾单位（肾脏）接受了治疗。其中，2例无需治疗，2例行开放手术，15例行软性输尿管镜治疗。接受软性输尿管镜治疗的患者平均结石负荷为18mm，但8例患者结石负荷>15mm，这些患者的平均结石负荷为23mm。所有患者均成功治疗或症状缓解。无重大并发症。
肥胖日益普遍，且与高发病率的合并症和并发症相关。成像可能困难，治疗选择有限。软性输尿管镜已被证明是最成功的治疗选择，可避免更具侵入性的手术。此外，这些患者可以成功处理大于正常可接受范围的结石负荷，鉴于其他技术存在的问题，应尝试进行此类治疗。
