Obesity might not be a disadvantage for SWL treatment in children with renal stone

Abstract

Although the management of urinary stones in obese patients is a challenge and the impact of the patient-related parameter has been well studied in adults: No study has evaluated the possible impact of obesity in terms of body mass index related SWL success in pediatric population. In this present study, we aimed to evaluate the safety and efficiency of SWL in obese children in a comparative manner with the cases in normal BMI value limits. A total of 66 children (45 boys and 21 girls, M/F:2.1) with renal calculi were treated with SWL. Depending on the BMI values, the children were divided into two groups as; Group 1 (n:50) children with normal BMI values (mean: 16.1) and Group 2 (n:16) obese children with higher BMI values (mean: 20.3). The success rates, complications, and need for auxiliary procedures after SWL were evaluated between two groups of patients in a comparative manner. While majority of the cases were treated under general anesthesia (n:61), a limited number of cases were treated under neurolept anesthesia with PiezoLith 3000 (Richard Wolf GmbH) lithotripter. Evaluation of efficiency was based on radiological examinations using abdominal radiography, ultrasonography, or CT scan when needed. Both the mean age and mean stone size values were similar in both groups. While the mean age was 62 months (24-148) in Group 1, this value was 68 months (24-137) in Group 2. Again mean stone size was 10.26 mm(5-25 mm) in Group 1 and 10.12 mm (6-20 mm) in Group 2. The mean number of SWL sessions and the number of SW's applied were similar in both groups (2.06 vs. 2.0 and 1975 vs. 1835, respectively). Evaluation of success rates after 3-months again did not show any statistically significant difference with respect to stone-free rates in both groups (47/50-94 %, 16/16-100 %, respectively). However, 3 children in Group 1 did show residual fragments (a parts per thousand currency sign3 mm) which were followed closely with regular visits without any problem. In another 3 cases, again fragments migrated to involved ureter after lithotripsy and these fragments were successfully treated in situ with further SWL. With respect to auxiliary procedures, there was no specific procedure has been done in Group 2, but 3 cases did undergo further SWL for ureteral stones in Group 1. Stone location did not affect the final outcome of the procedure in a significant manner in both groups. Lastly, no serious complication could be demonstrated in both groups either during or after SWL procedures. In the light of the successful treatment outcomes with limited need for auxiliary procedures in both groups, we may say that obesity might not be a disadvantage for SWL in children with renal stones.