Volume 10, Issue 2
Original Article / Published: November 2022
V. Todorova, O. Gatsev, K. Hristov, P. Petrov, D. Petrova, K. Petkova, I. Saltirov
Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
Introduction and objective: With the increasing prevalence of urolithiasis, the world is also witnessing an epidemic of obesity. Management of such patients is challenging due to the body habitus and the presence of multiple comorbidities. It is unclear whether percutaneous nephrolithotomy (PCNL) has similar efficacy and safety in obese patients as compared to patients with normal body mass index (BMI). The objective of this study is to assess the impact of body mass index on the efficacy and safety of PCNL in patients with BMI > 30 kg/m2.
Material and methods: The medical records of 124 obese patients with BMI > 30 kg/m2, treated between January 2017 and September 2022 were retrospectively reviewed. All patients underwent standard PCNL with ultrasound probe disintegration of stones. Data on patients preoperative characteristics, stone free rates, operating times, intra- and postoperative complications were analysed.
Results: Patients’ mean age was 57.0±9.2. The majority of patients had at least one comorbidity – 53 (43.4%) had diabetes, 45 (36.3%) – hypertension and 7 (5.6%) had ischemic heart disease. 100 (80.6%) patients had BMI between 30-34 kg/m2, 12 (9.7%) – between 35-39.9 kg/m2 and 12 (9.7%) patients had BMI measured over 40 kg/m2. Mean stone length was 40.0±14.9 mm and mean stone width 29.3±28.7 mm. In the majority of patients 118 (95.2%) lower pole puncture was performed for access to the stone. 54 (43.5%) of the patients had staghorn stones and 58 (46.8%) had stones composed of uric acid. Mean operative time was 50.3±12.2 min and mean hospital stay 3.5±0.9 days. Stone-free rate after a single procedure was 80.6%. Postoperative complications were fever in 5 (4%) patients, haematuria in 2 (1.6%), formation of AV fistula in 2 (1.6%) and renal colic – in 3 (2.4%) patients. Management of these complications included medical treatment in 7 (5.6%) patients, double JJ stent insertion in 4 (3.2%) and angioembolization in 2 (1.6%).
Conclusions: PCNL is safe and effective procedure in obese patients with BMI > 30 kg/m2. BMI seems to have no impact the stone-free or complication rates, despite the potential difficulties in performing it in obese patients.
- Keheila M, Leavitt D, Galli R, Motamedinia P, Theckumparampil N, Siev M et al. Percutaneous nephrolithotomy in super obese patients (body mass index ≥ 50 kg/m²): overcoming the challenges. BJU Int. 2016 Feb;117(2):300-6. doi: 10.1111/bju.13155.
- Grasso M, Loisides P, Beaghler M, Bagley D. The case for primary endoscopic management of upper urinary tract calculi: I. A critical review of 121 extracorporeal shock-wave lithotripsy failures. Urology. 1995 Mar;45(3):363-71. doi: 10.1016/S0090-4295(99)80002-8.
- Calvert RC, Burgess NA. Urolithiasis and obesity: metabolic and technical considerations. Curr Opin Urol. 2005 Mar;15(2):113-7. doi: 10.1097/01.mou.0000160626.36236.22.
- Ferreira TAC, Dutra MMG, Vicentini FC, Szwarc M, Mota PKV, Eisner B et al. Impact of Obesity on Outcomes of Supine Percutaneous Nephrolithotomy. J Endourol. 2020 Dec;34(12):1219-1222. doi: 10.1089/end.2020.0576.
- World Health Organization (WHO): Obesity and overweight, January 2015. Available at: http://who.int/mediacentre/ factsheets/fs311/en (accessed April 1, 2015)
- Skolarikos A, Neisius A, Petrik A et al., members of the EAU Guidelines of Urolithiasis Panel. EAU guideline of Urolithiasis. Retrieved from https://uroweb.org/guidelines/urolithiasis. Accessed November 6th, 2022.
- Гъцев О, Христофоров С, Петров П, Петкова К, Петрова Д, Салтиров И. Сравнително проучване на минимално-инвазивна и стандартна перкутанна нефролитотрипсия при лечението на бъбречни камъни с размер 20 до 40 mm в диаметър. Ендоурология и минимално инвазивна хирургия. 2019; 7(1): 17-24.
- Wong Y, Cook P, Roderick P, Somani BK. Metabolic Syndrome and Kidney Stone Disease: A Systematic Review of Literature. J Endourol. 2016 Mar;30(3):246-53. doi: 10.1089/end.2015.0567.
- Петкова К, Салтиров И. Рискови фактори за постоперативен фебрилитет след стандартна перкутанна нефролитотомия. Ендоурология и минимално инвазивна хирургия. 2017; 5(2): 5-9.
- Tomaszewski JJ, Smaldone MC, Schuster T, Jackman SV, Averch TD. Outcomes of percutaneous nephrolithotomy stratified by body mass index. J Endourol. 2010 Apr;24(4):547-50. doi: 10.1089/end.2009.0431.
- Koo BC, Burtt G, Burgess NA. Percutaneous stone surgery in the obese: outcome stratified according to body mass index. BJU Int. 2004 Jun;93(9):1296-9. doi: 10.1111/j.1464-410X.2004.04862.x.
- Dauw CA, Borofsky MS, York N, Lingeman JE. Percutaneous Nephrolithotomy in the Superobese: A Comparison of Outcomes Based on Body Mass Index. J Endourol. 2016 Sep;30(9):987-91. doi: 10.1089/end.2016.0437.
- Maalouf NM, Sakhaee K, Parks JH, Coe FL, Adams-Huet B, Pak CY. Association of urinary pH with body weight in nephrolithiasis. Kidney Int. 2004 Apr;65(4):1422-5. doi: 10.1111/j.1523-1755.2004.00522.x.
- Nalbant I, Dede O, Sener NC, Ozturk U, Yesil S, Karakoyunlu AN et al. The Effect of Metabolic Syndrome on the Success and Complications of Percutaneous Nephrolitotomy. Metab Syndr Relat Disord. 2015 Nov;13(9):389-92. doi: 10.1089/met.2015.0041.
- Tefekli A, Kurtoglu H, Tepeler K, Karadag MA, Kandirali E, Sari E et al. Does the metabolic syndrome or its components affect the outcome of percutaneous nephrolithotomy? J Endourol. 2008 Jan;22(1):35-40. doi: 10.1089/end.2007.0034.
- Andreoni C, Afane J, Olweny E, Clayman RV. Flexible ureteroscopic lithotripsy: first-line therapy for proximal ureteral and renal calculi in the morbidly obese and superobese patient. J Endourol. 2001 Jun;15(5):493-8. doi: 10.1089/089277901750299285.
- Pearle MS, Nakada SY, Womack JS, Kryger JV. Outcomes of contemporary percutaneous nephrostolithotomy in morbidly obese patients. J Urol. 1998 Sep;160(3 Pt 1):669-73. doi: 10.1097/00005392-199809010-00006. PMID: 9720518.
- Fuller A, Razvi H, Denstedt JD, Nott L, Hendrikx A, Luke M et al. The clinical research office of the endourological society percutaneous nephrolithotomy global study: Outcomes in the morbidly obese patient – a case control analysis. Can Urol Assoc J. 2014 May;8(5-6):E393-7. doi: 10.5489/cuaj.2258.
PCNL, obesity, BMI, urolithiasis
How to cite this article:
Todorova V, Gatsev O, Hristov K, Petrov P, Petrova D, Petkova K, Saltirov I. Efficacy and safety of percutaneous nephrolithotomy in patients with body mass index over 30 kg/m2. Journal of Endourology and Minimally Invasive Surgery (Bulgaria), 2022; 10(2): 66-71
Dr Victoria Todorova
Department of Urology and Nephrology
Military Medical Academy of Sofia
3 “Georgi Sofiiski” blvd.
Sofia 1606, Bulgaria
E-mail: firstname.lastname@example.org Web: www.urology-vma.bg