Karatzas Anastasios, Gravas Stavros, Tzortzis Vassilios, Aravantinos Evangelos, Zachos Ioannis, Kalogeras Nikolaos, Melekos Michael
Department of Urology, University of Thessaly School of Medicine, Mezourlo, 41110 Larissa, Greece.
Urol Res. 2012 Aug;40(4):355-9. doi: 10.1007/s00240-011-0416-4. Epub 2011 Aug 17.
The aim of our study was to evaluate the efficacy and safety of ESWL using a modified lateral position in obese patients with renal stones. Nineteen obese patients with renal stones were enrolled (group A). The mean stone diameter was 1.3 cm (0.7-1.9 cm). The mean BMI was 35.1 kg/m² (31-41 kg/m²). Patients were placed in the lateral position, with the energy source facing their body posteriorly and the site where the stone was located in direct contact with the water cushion. Success rate (defined as the percentage of patients who were stone-free or with insignificant fragments after 3 months), mean number of ESWL sessions, mean duration of ESWL session and complications were recorded. The results were compared with those of 17 obese patients (Group B) with similar baseline characteristics treated in the standard supine position. All ESWLs were performed using the Dornier lithotripter SII. Both success rate (68.4 vs. 64.7% for groups A and B, respectively) and mean number of sessions (2.2 vs. 2.6) did not differ significantly between the two groups (p = 0.5). Interestingly, the time required to complete ESWL was significantly shorter for group A patients (56 min) compared to group B (73 min) (p = 0.001). No severe complications (including hematoma, pyelonephritis) were recorded. Our data indicate that ESWL in the modified lateral position for renal calculi in obese patients seems to be feasible and safe. In addition, it is faster than in the supine position since it overcomes technical difficulties. Further studies with a large number of patients are required to support our findings.
我们研究的目的是评估在肥胖肾结石患者中采用改良侧卧位进行体外冲击波碎石术（ESWL）的疗效和安全性。纳入了19例肥胖肾结石患者（A组）。结石平均直径为1.3 cm（0.7 - 1.9 cm）。平均体重指数（BMI）为35.1 kg/m²（31 - 41 kg/m²）。患者取侧卧位，能量源朝向其身体后方，结石所在部位与水垫直接接触。记录成功率（定义为3个月后结石清除或残留微小碎片的患者百分比）、ESWL治疗次数、每次ESWL治疗的平均时长以及并发症情况。将结果与17例采用标准仰卧位治疗的具有相似基线特征的肥胖患者（B组）进行比较。所有ESWL均使用多尼尔SII型碎石机进行。两组的成功率（A组和B组分别为68.4%和64.7%）和平均治疗次数（2.2次和2.6次）差异均无统计学意义（p = 0.5）。有趣的是，A组患者完成ESWL所需时间（56分钟）明显短于B组（73分钟）（p = 0.001）。未记录到严重并发症（包括血肿、肾盂肾炎）。我们的数据表明，肥胖患者肾结石采用改良侧卧位进行ESWL似乎是可行且安全的。此外，由于克服了技术困难，其比仰卧位更快。需要大量患者的进一步研究来支持我们的发现。
