Outcomes of Systematic Review of Ureteroscopy for Stone Disease in the Obese and Morbidly Obese Population

Purpose: With a rising incidence of obesity and urolithiasis, we wanted to look at the outcomes of ureteroscopy (URS) for stone management in this group of patients. Methods: We did a systematic review of literature in accordance with Cochrane review and preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines on all English language articles between 1990 and June 2015 for URS and stone treatment in obese patients. Data were retrieved for patient and stone demographics, outcomes of URS, complications, and follow-up. Results: Fifteen studies (835 patients) were identified with a mean age of 49 years and a mean body mass index (BMI) of 40.5kg/m(2). The overall stone size was 14.2mm (range: 3-72mm) with almost a third of the stones in the lower pole. The initial and final stone-free rate (SFR) was 76.9% and 82.5%, respectively, with an overall complication rate of 9.3% (n=78). Except one patient with myocardial infarction, all other complications were Clavien grade I-III. The complication rate for morbidly obese patients (17.6%) was twice that of the obese patients (8.4%), although they were all graded as Clavien I or II. Conclusion: URS and stone fragmentation are safe and efficient treatment methods in obese patients with a good SFR and a relatively low complication rate, although the complications tend to be higher in the morbidly obese patients.