A 40 year old gentleman came with right flank pain. He was found to have right upper calyceal calculus of 9 mm.He had morbidly obese body predisposition.
He was a known case of hypertension otherwise he didn't have any other comorbidities. His biochemical and hematological tests were normal. He was evaluated by our cardiologists .His cardiac evaluation was normal.
In Ramayya Pramila hospital it is routine protocol to evaluate all patients cardiologically if they are above 50 years, history of hypertension, diabetes and high BMI( obese or morbidly obese).
In morbidly obese patients, since the kidney and stone are at a considerable distance from the skin (compared to non-obese patients) difficulty may be found in positioning the patient so that the stone is situated at the focal point of the lithotripter. So focusing these stones is a challenging task. Also the anesthesia itself carries a significant risk.
It has been noticed that even the stone is kept within 3 cm of the focal distance( extended focal distance) the ESWL can be carried out. We did this case and got a very good focusing and fragmentation on real time imaging.
Thanks for sharing the report on eswl in morbidly obese patients .
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