What challenges do obese patients with urological disorders present, and how do you handle them? Are there specific conditions that should be treated differently?
The biggest problem for urologists is really related to surgery. We need to use special equipment and tools for the morbidly obese. It’s more difficult to open the abdomen of obese patients, and they are more at risk for wound complications, infections, and incisional hernias. They are also at risk for complications, such as cardiac issues, during the surgery itself.

There is also the issue of medical imaging. Urologists rely heavily on CT scans and MRIs, but often morbidly obese patients won’t fit into the scanner, which makes it very difficult for the physician and embarrassing for the patient. In extreme cases, we’ve had to send patients to veterinary facilities for imaging because they are better equipped to handle their size.

When it comes to treatment, physicians working with obese patients shouldn’t jump right to medication for problems, such as sexual dysfunction. Often these patients don’t need a prescription for drugs like Viagra; they simply need to lose weight and exercise to manage their disease. There is also some evidence that for men with low-risk prostate cancer, which is under surveillance, lifestyle changes may prevent changes to their condition, such as the detection of fewer suspicious PSA levels.

For patients suffering from kidney stones, dietary changes are critical in preventing a recurrence. But it can be challenging to encourage people to make lifestyle changes to improve their health. In adult men, sexual dysfunction risk is a nice carrot that physicians can use to lead a patient to take his weight issues seriously. In adolescents who have actually suffered a painful kidney stone, they may gain motivation for lifestyle changes to prevent another.

1. Centers for Disease Control and Prevention. Adult Obesity Facts. Available at http://www.cdc.gov/obesity/data/adult.html. Accessed on Nov. 27, 2012.

2. Centers for Disease Control and Prevention. Childhood obesity facts. Available at: http://www.cdc.gov/healthyyouth/obesity/facts.htm. Accessed on Nov. 27, 2012.

3. Mogri M, Dhindsa S, Quattrin T, et al. Testosterone Concentrations in Young Pubertal and Post-Pubertal Obese Males. Clin Endocrinol. 2012 Sep 13. [Epub ahead of print].

4. Vivante A, Golan E, Tzur D, et al. Body Mass Index in 1.2 Million Adolescents and Risk for End-Stage Renal Disease. Arch Intern Med. 2012;172(21):1644–1650.