Safety and efficacy of ureteroscopic lithotripsy for stone disease in obese patients: a systematic review of the literature.

OBJECTIVE To look at the role and safety of ureteroscopy for stone management in obese patients. METHODS We searched MEDLINE, PubMed and the Cochrane Library from January 1990 to June 2011 for results of ureteroscopy and stone treatment in obese patients. Inclusion criteria were all English language articles reporting on ureteroscopy in patients with morbid obesity. Data on the outcomes and complications was extracted and a meta-analysis of the results conducted. RESULTS Seven studies with 131 patients (136 renal units) were included. All the studies included obese patients (mean BMI 42.2) treated with flexible URS for urinary calculi. The mode of fragmentation was pulse dye laser, holmium laser, and combined modality including electrohydraulic lithotripsy and basket retrieval in others. The average stone size was (1.37). The stone free rate was 87.5% after completion of treatment with a ranged follow up between 3 months and 3.5 years. The mean operative time was 97.1 minutes (30-275). There was an overall 11.4% complication rate, however, none of the patients needed further monitoring and were treated conservatively. A sub-group analysis of the stones depending on size found the URS has a higher stone free rate in stones <2 cm in size (P = 0.0003). Furthermore, URS has a higher stone free rate when treating ureteric stones compared to renal stones (P = 0.04). CONCLUSION Retrograde stone treatment using ureteroscopy is a safe and efficient modality for treating obese patients with urinary tract calculi with an increased efficiency with smaller stones less than 2 cm in size.