Percutaneous nephrolithotomy in super obese patients (body mass index ≥ 50 kg/m<sup>2</sup>): overcoming the challenges

Keheila, Mohamed; Leavitt, David; Galli, R.; Motamedinia, Piruz; Theckumparampil, Nithin; Siev, Micheal; Hoenig, David M.; Smith, Arthur D.; Okeke, Zeph

doi:10.1111/bju.13155

Cited by 23 publications

(16 citation statements)

References 39 publications

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“…They emphasize the importance of the entire care team, incorporating an anesthesiologist comfortable with prone positioning and airway concerns in obese patients. 17 While the two previously described studies have demonstrated the feasibility of PCNL in even the largest patients, ours is the first to indicate acceptable outcomes with PCNL in a direct comparison between superobese patients and those with lower BMI. These findings are important in the context of the increasing use of flexible ureteroscopy, especially for larger renal stones.…”

Section: Discussionmentioning

confidence: 51%

“…11 Several studies have documented the feasibility, safety, and efficacy of PCNL in obese patients. [12][13][14] However, limitations such as small sample size, 15 lack of comparator groups, 16,17 or few patients at BMI extremes 18 have led some experts to assert that alternative treatment modalities, namely flexible ureteroscopy, be considered first-line therapy. 19 Herein, we present our experience and outcomes following PCNL in patients across a wide range of BMI from a large, single-institutional contemporary dataset.…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous Nephrolithotomy in the Superobese: A Comparison of Outcomes Based on Body Mass Index

Dauw

Borofsky

York

et al. 2016

Journal of Endourology

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Introduction: Percutaneous nephrolithotomy (PCNL) is considered the gold standard for treatment of large renal calculi. Although several investigators have examined the feasibility and outcomes associated with PCNL in obese patients, these studies have been limited by small sample size, lack of a comparator group, or few patients at body mass index (BMI) extremes. We thus compared outcomes of superobese (BMI >50) patients undergoing PCNL vs both an ''overweight'' and ''ideal'' cohort. Methods: We used a prospectively maintained database to identify ideal (BMI 18.5-25), overweight (BMI 25.1-49.9), and superobese (BMI ‡50) patients who underwent PCNL. Our primary objective was to compare surgical outcomes between groups measured by the percent of patients who required secondary PCNL. We then compared complication rates, need for transfusion, and length of stay (LOS) using chi-square testing and ANOVA where appropriate. Results: A total of 1152 patients were identified of which 254 were classified as ideal, 840 as overweight, and 58 as superobese. The overweight cohort had a higher mean age and greater proportion of males, whereas staghorn stones were more common in the superobese group. Comorbid conditions were more commonly observed in the superobese cohort. Otherwise, the groups were similar. Surgical outcomes were comparable with 47.2%, 42.0%, and 38.0% of ideal, overweight, and superobese patients requiring secondary PCNL ( p = 0.25) with no difference in complication rates, need for transfusion, or LOS. Conclusion: PCNL can be effectively and safely performed in superobese patients with no difference in surgical outcomes or complications when compared to ideal or overweight patient cohorts.

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Section: Discussionmentioning

confidence: 51%

Section: Introductionmentioning

confidence: 99%

Percutaneous Nephrolithotomy in the Superobese: A Comparison of Outcomes Based on Body Mass Index

Dauw

Borofsky

York

et al. 2016

Journal of Endourology

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“…Further randomized clinical trials of a large sample size in obese patients are required to recommend an extensive application of supine PCNL as an alternative to prone PCNL. The recognized challenges and effects in the application of PCNL in obese patients also include poor radiographic or ultrasonographic visualization, difficulties in identifying anatomic landmarks and in reaching the kidney because of excess fat tissue, stone location, and the safe positioning of patients [21] . The calyceal site was associated with decreased fitness for surgery and an increased risk of postoperative complications compared to the renal site [27] .…”

Section: Discussionmentioning

confidence: 99%

Effect of Obesity on Outcomes of Percutaneous Nephrolithotomy in Renal Stone Management: A Systematic Review and Meta-Analysis

Zhou

Sun²,

Chen³

et al. 2017

Urol Int

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length of hospital stay after treatment existed between super-obese and normal-weight individuals (95% CI -0.15 to 0.37, p = 0.39). Additionally, no obvious differences in terms of operation time existed between obese and normal-weight individuals (95% CI -3.36 to 1.17, p = 0.34). However, the operation time was longer among super-obese individuals than among normal-weight individuals (95% CI -22.64 to -1.40, p = 0.03), and the length of hospital stay was shorter among obese patients than among normal-weight patients (95% CI 0.04-0.34, p = 0.01). No publication bias was observed in this work. Conclusion: The PCNL performed in normal-weight, obese, and super-obese individuals for kidney stone treatment showed similar outcomes, except that operation time was longer among super-obese individuals and the hospital stay was shorter in obese individuals than in other groups. Thus, PCNL is a safe and efficacious treatment for renal stones in patients of all sizes. © 2017 S. Karger AG, Basel IntroductionThe prevalence of obesity is increasing in the global context. The number of obese individuals has rapidly increased in recent years both in developed and developing countries [1] . The prevalence of overweight and Keywords Renal stones · Percutaneous nephrolithotomy · Obesity · Complications · Stone-free rate · Operative time · Length of hospital stay Abstract Background: Percutaneous nephrolithotomy (PCNL) has been widely used to treat renal stones. The application of PCNL in obese patients results in the emergence of a number of challenges. This study compared the effect of obesity on the outcomes of PCNL in kidney stone treatment. Methods: Eligible studies were searched in PubMed, Web of Science, and Cochrane Library databases. Data were analyzed using RevMan statistical software, weighted mean differences, ORs, and 95% CIs were calculated. Results: Seven studies involving 2,720 normal-weight, 1,686 obese, and 286 superobese individuals were included in this meta-analysis. A pooled analysis of safety revealed that no obvious differences in terms of complication rates after treatment existed between obese and normal-weight individuals (OR 0.97, 95% CI 0.80-1.16, p = 0.73), and between super-obese and normal-weight individuals (OR 0.88, 95% CI 0.61-1.27, p = 0.49). A pooled analysis of effectiveness revealed that no obvious difference in terms of stone-free rate after treatment existed between obese and normal-weight individuals (OR 0.98, p = 0.79), and between superobese and normal-weight individuals (OR 1.20, p = 0.25). Moreover, no obvious differences in terms of

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“…Preoperative considerations and instrument modifications were suggested for overcoming certain challenges; those included using the shortest possible access tract, extra long access sheaths, wide incision of the skin and subcutaneous tissue in addition to postoperative drainage with nephroureteric tubes rather than with nephrostomy tubes. 9 In terms of blood transfusion rates, obesity was not associated with an increase need of blood transfusions. This study showed that transfusion requirements among the 4 groups was not statistically significant (p=0.103).…”

Section: Discussionmentioning

confidence: 91%

Prone PCNL: Safety and efficacy in obese and morbidly obese patients

Jabbour¹,

Jabbour²,

Zgheib³

2018

UNOAJ

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Introduction: The use of percutaneous nephrolithotomy (PCNL) in obese patients with nephrolithiasis has been a subject of debate. Numerous publications have debated the pros and cons of this procedure. In order to assess the efficacy and feasibility of this technique in patients with a BMI>25 kg/m2, several factors should be studied and compared. Purpose: The purpose of this study is to prove the efficacy and safety of prone PCNL in obese patients and to compare preoperative, intraoperative and postoperative variables between obese patients and those with normal BMI. Methods: Data was collected throughout 7 years on all patients presenting for PCNL at our institution. All patients underwent prone PCNL under fluoroscopy by a single urologist and the need for subsequent procedure was studied. A total of 276 patients were grouped, after applying exclusion criteria, into 4 categories according to their BMI: Normal BMI (72), overweight (112), obese (80) and Morbidly Obese (12). Using statistical analysis data was compared among the 4 groups of BMI. Results: The risk of intraoperative related complications including pneumothorax and bleeding was the same among the 4 study groups (p=0.07). No difference was found in terms of subcostal v/s intercostal access (p=0.068). 8%, 1.79%, 8.54% and 0% of the normal, overweight, obese and morbidly obese respectively required transfusions (p=0.103). No significant difference (p=0.07) was found among the groups in overall complication rates being 12% in the Normal BMI group,16% in the overweight, 10% in the obese, and 21% in the morbidly obese. Mean operative time was 84.39, 85.45, 97.31 and 122.5 min in the normal, overweight, obese and morbidly obese respectively (p=0.01). Stone free rate was 52% in the normal BMI group, 62% in the overweight, 66% in the obese and 50% in the morbidly obese (p=0.268). Conclusion: PCNL in obese patients, BMI>25 kg/m2, was associated with a longer operative time, but with similar rate of complications, transfusion requirements and the need for subsequent procedures when compared to patients with normal BMI. This pioneer study in the Middle East establishes PCNL as safe and feasible procedure in obese patients.

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Percutaneous nephrolithotomy in super obese patients (body mass index ≥ 50 kg/m²): overcoming the challenges

Cited by 23 publications

References 39 publications

Percutaneous Nephrolithotomy in the Superobese: A Comparison of Outcomes Based on Body Mass Index

Percutaneous Nephrolithotomy in the Superobese: A Comparison of Outcomes Based on Body Mass Index

Effect of Obesity on Outcomes of Percutaneous Nephrolithotomy in Renal Stone Management: A Systematic Review and Meta-Analysis

Prone PCNL: Safety and efficacy in obese and morbidly obese patients

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Percutaneous nephrolithotomy in super obese patients (body mass index ≥ 50 kg/m2): overcoming the challenges

Cited by 23 publications

References 39 publications

Percutaneous Nephrolithotomy in the Superobese: A Comparison of Outcomes Based on Body Mass Index

Percutaneous Nephrolithotomy in the Superobese: A Comparison of Outcomes Based on Body Mass Index

Effect of Obesity on Outcomes of Percutaneous Nephrolithotomy in Renal Stone Management: A Systematic Review and Meta-Analysis

Prone PCNL: Safety and efficacy in obese and morbidly obese patients

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Percutaneous nephrolithotomy in super obese patients (body mass index ≥ 50 kg/m²): overcoming the challenges