Özgü AYDOĞDU, İBRAHİM HALİL BOZKURT, Tarık YONGUÇ, Tansu DEĞİRMENCİ, Salih POLAT, Volkan ŞEN, Zafer KOZACIOĞLU, BÜLENT GÜNLÜSOY, Süleyman MİNARECİ

Obezite ve perkütan nefrolitotomi (PNL): Vücut kitle indeksinin PNL sonuçları üzerindeki etkisi

Amaç: Bu çalışmada obezitenin perkütan nefrolitotomi (PNL) yapılan hastalarda postoperatif sonuçlar ve komplikasyonlar üzerindeki potansiyel etkisinin araştırılması amaçlanmıştır. Gereç ve yöntem: Çalışmaya kliniğimizde 2009 ve 2014 yılları arasında PNL gerçekleştirilen ve kayıtlarına ulaşılabilen 428 hasta dahil edildi. Hastalar obezite değerlendirilmesi açısından vü- cut kitle indeksine (VKİ) göre dört grupta incelendi. Grup 1 de normal kilolu (VKİ 40 kg/m2) olan hastalar yer aldı. Taş- ların tamamen temizlenmesi veya

Obesity and percutaneous nephrolithotomy (PNL): The effect of body mass index on PNL outcomes

Objective: In the present study we aimed to investigate the potential effect of obesity on postoperative outcomes and complications in patients who underwent percutaneous nephrolithotomy (PNL). Materials and Methods: 428 patients who underwent PNL in our clinic between 2009 and 2014 were included in our study. Patients were evaluated in 4 groups according to body mass index (BMI). Group 1 included normal weight (BMI <25 kg/m2), group 2 included overweight (BMI 25-30 kg/m2), group 3 included obese (BMI >30 kg/m2) and group 4 included morbidly obese (BMI >40 kg/m2) patients. Postoperative success was defined as stone free or residual fragments < 3mm. Four groups were compared for operation time, intraoperative bleeding, floroscopy time, hospitalization time, postoperative analgesic requirement, nephrostomy time, postoperative success rates, blood transfusion, and other major and minor complications. Statistical analyses were performed with SPSS version 17.0 and statistical significance was set at a p value of <0.05. Results: 297 patients were men and 131 were women. Mean age was 44.3 (19-74) years. Totally PNL was performed in 454 renal units. 123 (29%), 174 (41%), 102 (24%) and 29 (6%) patients were normal weight, over weight, obese and morbidly obese respectively. No significant difference was noted between the groups in terms of intraoperative bleeding, hospitalization time, postoperative analgesic requirement, nephrostomy time, postoperative success rates, blood transfusion, and other major and minor complications. Floroscopy time and operation time were significantly higher in group 3 and group 4 when compared to other groups. Conclusion: Although operation and floroscopy time are longer, PNL is a minimal invasive surgical method which can be performed in obese patients with similar success and complication rates in normal weight patients.

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1. Koo BC, Burtt G and Burgess NA. Percutaneous stone surgery in the obese: outcome stratified according to body mass index. BJU Int 2004; 93: 1296-1299.
2. Fuller A, Razvi H, Denstedt JD, Nott L, Hendrix A, Luke M, Pal SK, Rosette J. The clinical research office of the endourological society percutaneous nephrolithotomy global study: outcomes in the morbidly obese patient-a case control analysis. CUAJ 2014; 8: 393-397.
3. El-Asmy AM, Shokeir AA, El-Nahas AR, Shoma AM, Eraky I, El-Kenawy MR, El-Kappany HA. Outcome of percutaneous nephrolithotomy: effect of body mass index. Eur Urol 2007; 52: 199-205.
4. Kelly T, Yang W, Chen CS, et al. Global burden of obesity in 2005 and projections to 2030. Int J Obes 2008;32:1431-7.
5. Taylor EN, Stampfer MJ, Curhan GC. Diabetes mellitus and the risk of nephrolithiasis. Kidney Int 2005;68:1230-5.
6. Taylor EN, Stampfer MJ, Curhan GC. Obesity, weight gain, and the risk of kidney stones. JAMA 2005;293:455-62.
7. Thomas R, Cass AS. Extracorporeal shock wave lithotripsy in morbidly obese patients. J Urol 1993;150:302.
8. Calverta RC, Burgess NA. Urolithiasis and obesity: metabolic and technical considerations. Curr Opin Urol 2005;15:1137.
9. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: a review. J Am Coll Surg 1997; 185: 593-603.
10. Nguyen TA, Belis JA. Endoscopic management of urolithiasis in the morbidly obese patient. J Endourol 1998;12:33 5.
11. 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;15:4938.
12. Dash A, Schuster TG, Hollenbeck BK, Faerber GJ, Wolf Jr JS. Ureteroscopic treatment of renal calculi in morbidly obese patients: a stone-matched comparison. Urology 2002;60:3937.
13. Manohar T, Jain P, Desai M. Supine percutaneous nephrolithotomy: effective approach to high risk and morbidly obese patients. J Endourol 2007;21:44-9.
14. Gofrit ON, Shapiro A, Donchin Y, et al. Lateral decubitus position for percutaneous nephrolithotripsy in the morbidly obese or kyphotic patient. J Endourol 2002;16:3836.
15. Curtis R, Thorpe AC, Marsh R. Modification of the technique of percutaneous nephrolithotomy in the morbidly obese patient. Br J Urol 1997;79:13840.
16. Giblin JG, Lossef S, Pahira JJ. A modification of standard percutaneous nephrolithotripsy technique for the morbidly obese patient. Urology 1995;46:4913.
17. Carson III CC, Danneberger JE, Weinerth JL. Percutaneous lithotripsy in morbid obesity. J Urol 1988;139:2435.
18. El-Assmy AM, Shokeir AA, El-Nahas AR, et al. Outcome of percutaneous nephrolithotomy: effect of body mass index. Eur Urol 2007;52:199-205.
19. Faerber GJ, Goh M. Percutaneous nephrolithotripsy in the morbidly obese patient. Tech Urol 1997;3:8995.
20. Streem SB, Yost A, Mascha E. Clinical implications of clinically insignificant stone fragments after extracorporeal shock wave lithotripsy. J Urol 1996; 155: 1186-1190.
21. Torrecilla Ortiz C, Meza Martínez AI et al. Obesity in percutaneous nephrolithotomy. Is body mass index really important? Urology 2014;84:538-43.
22. Kuntz NJ, Neisius A, Astroza GM et al. Does body mass index impact the outcomes of tubeless percutaneous nephrolithotomy? BJU Int 2014;114:404-11.