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Ureteroscopy with laser lithotripsy in obese and diabetic patients is associated with an increased risk of complications
Melody Chen, MD, Nannan Thirumavalavan, MD, Mark Katz, MD, Richard Babayan, MD, David S. Wang, MD.
BOSTON UNIVERSITY MEDICAL CENTER, BOSTON, MA, USA.

Ureteroscopy with laser lithotripsy in obese and diabetic patients is associated with an increased risk of complications
Introduction and Objective
Obesity and diabetes are prevalent in the United States. It is felt that these risk factors may increase the risk of surgery. The objective of this study was to determine if diabetes and obesity increased complications in patients undergoing ureteroscopy (URS) with laser lithotripsy.
Methods
Retrospective chart review was conducted on all URS cases for renal and ureteral stones performed by three surgeons at one institution from January 2007 to January 2013. The factors assessed included body mass index (BMI), history of diabetes mellitus, hypertension, hyperlipidemia, hepatitis C, or coronary artery disease. Reviewed complications included UTI, urosepsis, readmission, or requirement of second procedure.
Results
Seven hundred ninety-nine patients were identified. Mean patient age was 51 years and average body mass index was 30.0 kg/m2. Average stone size was 8.9 mm. The overall stone-free rate was 97%, with no differences in success rates in diabetic and obese patients. Complication rates between normal and overweight patients were 11.5% and 10.2%, respectively. However, complication rates in obese patients (BMI>30) was higher at 16%. Patients with diabetes mellitus had a higher complication rate of 22%. BMI and history of diabetes mellitus were significantly associated with complications on univariate analysis. Other factors such as hypertension, HIV, hyperlipidemia, history of Hepatitis C, and hypothyroidism were not found to be significantly associated with complications. On multivariate analysis, only diabetes mellitus was found to be significantly associated with an increased number of complications.
Conclusions
In this study, patients with obesity and diabetes mellitus had a higher rate of complications following ureteroscopy with laser lithotripsy. However, on multivariate analysis only diabetes was associated with a higher complication rate. The overall stone free rate was no different in patients with obesity or diabetes mellitus. Urologists should be aware of the increased risk of complications following ureteroscopy with laser lithotripsy in this group of patients.
Table 1.
BMINo. of ComplicationsTotal No.Percent Complication
Normal18.5-24.92219011.5%
Overweight25-29.92726410.2%
Obese>305634516.2%

Table 2.
Complication Rate
Diabetes Mellitus36/163 (22%)p < 0.05
Hypertension43/280 (15%)p > 0.05
HIV2/8 (25%)p > 0.05
Hyperlipidemia14/93 (15%)p > 0.05
Hepatitis C6/29 (21%)p > 0.05
Hypothyroidism3/25 (12%)p > 0.05


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