Effect of obesity on percutaneous nephrolithotomy outcomes in Staghorn stones

Abstract

Objective: In this study, we aimed to compare the success and complication rates of percutaneous nephrolithotomy (PCNL) in obese patients with staghorn renal stones.
Material and Methods: Between January 2012 and December 2017, 183 patients who had single access PCNL for staghorn renal calculi were evaluated retrospectively. Patients were divided into two groups according to body mass index (BMI). The patients with BMI < 30 kg/mm2 and >30 kg/mm2 were defined group-1 and group-2, respectively. Among the groups, we compared demographic characteristics, perioperative and postoperative datas.
Postoperatively, >4 mm stone was identified as residual fragment. Complications were classified according to the Clavien scoring system.
Results: In our study, there were 127 and 56 patients with staghorn renal calculi in the Group-1 and Group-2, respectively. The mean BMI were 24.5±2.7 kg/mm2 and 32.3±2.2 kg/mm2 in the Group-1 and Group-2, respectively ( p=0.001). The number of patients with metabolic syndrome was also statistically significant higher in group-2 ( p=0.001). The mean stone size were 848±302 mm2 and 1020±197 mm2 in the Group-1 and Group-2, respectively ( p=0.535).
Operation, nephroscopy and fluoroscopy times were similar between the groups (p=0.800, p=0.123, p=0.107 respectively). When we evaluated the postoperative results, stone-free rates were 55.6% and 62.5% in group-1 and group-2, respectively (p=0.381). Total complication rates were 38.9% and 33.9% in group-1 and group-2, respectively (p = 0.523).
Investigating the subgroups of complications according to the Clavien scoring system, the rate of minor complications were 27.6% and 25.0% in the group-1 and group-2, respectively and this difference was not statistically significant (p = 0.697). Major complication rates were 11.0% and 8.9% in the group-1 and group-2, respectively (p=0.657).
Conclusion: PCNL is an effective and safe treatment method for staghorn stones in obese patients.

Keywords

• Percutaneous nephrolithotomy
• Staghorn renal calculi
• Clavien scoring system
• Obesity
• Body mass index

Staghorn taşlarda obezitenin perkütan nefrolitotomi sonuçları üzerine etkisi

Abstract

Amaç: Bu çalışmada, staghorn böbrek taşlarında, obezitenin perkütan nefrolitotomi (PCNL) başarısı ve komplikasyonları üzerine etkisini değerlendirmeyi amaçladık.
Gereç ve Yöntemler: 2012 ile 2017 yılları arasında staghorn böbrek taşı nedeniyle tek akses PCNL uygulanan 183 hastanın dosyaları retrospektif olarak incelendi. Hastalar vücut kitle indekslerine (VKİ) göre iki gruba ayrıldı. VKİ < 30 kg/mm2 olan hastalar Grup-1, > 30 kg/mm2 olan hastalar ise Grup-2 olarak tanımlandı. Bu iki grup arasında hastaların demografik özellikleri, perioperatif ve postoperatif sonuçları karşılaştırıldı.
Operasyon sonrası >4 mm taş saptanması rezidü olarak tanımlandı. Komplikasyonlar Clavien skorlama sistemine göre sınıflandırıldı.
Bulgular: Çalışmaya dahil edilen 183 staghorn böbrek taşı olan hastanın 127’si Grup-1 de 56’sı ise Grup-2’deydi. Hastaların ortalama VKİ leri grup-1 ve grup-2’de sırasıyla 24.5±2.7 kg/mm2 ve 32.3±2.2 kg/mm2 idi (p=0.001). Metabolik sendrom saptanan hasta sayısı da anlamlı olarak grup-2’de daha fazlaydı (p=0.001). Grup-1 ve Grup-2’deki ortalama taş büyüklüğü sırasıyla 848±302 mm2 ve 1020±197 mm2 idi ( p=0.535). Operasyon verilerine baktığımızda, gruplar arasında operasyon, nefroskopi ve skopi süreleri benzerdi (sırasıyla p=0.800, p=0.123, p=0.107). Postoperatif sonuçları değerlendirdiğimizde, Grup-1’de taşsızlık % 55.6 olarak saptanırken grup-2’de bu oran % 62.5 idi (p=0.381). Total komplikasyon oranlarına baktığımızda ise grup-1’de % 38.9 hastada komplikasyon saptanırken, grup-2’de % 33.9 hastada komplikasyon saptandı (p=0.523).
Clavien skorlama sistemine göre komplikasyonların alt gruplarını incelediğimizde minör komplikasyon oranı grup-1’de % 27.6 iken grup-2’de % 25.0 olarak saptandı ve bu fark istatistiksel olarak anlamlı değildi (p=0.697). Majör komplikasyon oranı ise grup-1 ve grup-2’de sırasıyla %11.0 ve % 8.9 olarak bulundu (p=0.657).
Sonuç: PCNL, obez hastalarda da kompleks taşların tedavisinde etkin ve güvenilir bir tedavi yöntemi olarak kullanılabilir.

Keywords

• Perkütan nefrolitomi
• Staghorn böbrek taşı
• Clavien skorlama sistemi
• Obezite
• Vücut kitle indeksi

References

1. Ganpule AP, Desai M. Management of the staghorn calculus: Multiple-tract versus single-tract percutaneous nephrolithotomy. Curr Opin Urol 2008;18:220–223. doi: 10.1097/MOU.0b013e3282f3e6e4.
2. Taylor EN, Stampfer MJ, Curhan GC. Obesity, weight gain, and the risk of kidney stones. JAMA 2005;293:455-62. doi: 10.1001/jama.293.4.455.
3. Asplin JR. Obesity and urolithiasis. Adv Chronic Kidney Dis 2009;16:11-20. doi: 10.1053/j.ackd.2008.10.003.
4. Türk C, Petřík A, Sarica K, et al. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2016;69:475-82. doi: 10.1016/j.eururo.2015.07.041.
5. Wollin DA, Preminger GM. Percutaneous nephrolithotomy: complications and how to deal with them. Urolithiasis 2018;46:87–97. doi: 10.1007/s00240-017-1022-x.
6. Desai M, Jain P, Ganpule A, et al. Developments in technique and technology: the effect on the results of percutaneous nephrolithotomy for staghorn calculi. BJU Int. 2009;104:542-548. doi: 10.1111/j.1464-410X.2009.08472.x.
7. Desai M, De Lisa A, Turna B, et al. The clinical research office of the endourological society percutaneous nephrolithotomy global study: Staghorn versus non staghorn stones. J Endourol 2011;25:1263-8. doi: 10.1089/end.2011.0055.
8. Al-Kohlany KM, Shokeir AA, Mosbah A, et al. Treatment of complete staghorn stones: a prospective randomized comparison of open surgery versus percutaneous nephrolithotomy. J Urol 2005;173:469–473. doi: 10.1097/01.ju.0000150519.49495.88.

9. Flancbaum L, Choban PS. Surgical implications of obesity. Annu Rev Med 1998;49:215-34. doi: 10.1146/annurev.med.49.1.215.
10. Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: a review. J Am Coll Surg 1997;185:593-603. doi: 10.1016/s1072-7515(97)00109-9.
11. Kurzer E, Leveillee R, Bird V. Obesity as a risk factor for complications during laparoscopic surgery for renal cancer: multivariate analysis. J Endourol 2006;20:794-9. doi: 10.1089/end.2006.20.794.
12. Balentine CJ, Wilks J, Robinson C, et al. Obesity increases wound complications in rectal cancer surgery. J Surg Res 2010;163:35-9. doi: 10.1016/j.jss.2010.03.012.
13. Neligan PJ. Metabolic syndrome: anesthesia for morbid obesity. Curr Opin Anaesthesiol 2010;23:375-83. doi: 10.1097/aco.0b013e328338caa0.
14. Vujovic A, Keoghane S. Management of renal stone disease in obese patients. Nat Clin Pract Urol 2007;4:671-6. doi: 10.1038/ncpuro0988.
15. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-13. doi: 10.1097/01.sla.0000133083.54934.ae.
16. Tiselius HG, Andersson A. Stone burden in an average Swedish population of Stone formersrequiringactive Stone removal: how can thestone size be estimated in the clinical routine? Eur Urol 2003;43:275-81. doi: 10.1016/s0302-2838(03)00006-x.
17. Canoy D, Bundred P. Obesity in children. BMJ Clin Evid. 2011;2011:0325.
18. Fontaine KR, Redden DT, Wang C, et al. Years of life lost due to obesity. JAMA 2003;289:187-93. doi: 10.1001/jama.289.2.187.
19. Calvert RC, Burgess NA. Urolithiasis and obesity: metabolic and technical considerations. Curr Opin Urol. 2005;15:113-117. doi: 10.1097/01.mou.0000160626.36236.22.
20. Hawn MT, Bian J, Leeth RR, et al. Impact of obesity on resource utilization for general surgical procedures. Ann Surg. 2005;241:821- 826; discussion 826-828. doi: 10.1097/01.sla.0000161044.20857.24.
21. Chang SS, Duong DT, Wells N, et al. Predicting blood loss and transfusion requirements during radical prostatectomy: the significant negative impact of increasing body mass index. J Urol. 2004; 171:1861-1865. doi: 10.1097/01.ju.0000120441.96995.e3.
22. Lee CT, Dunn RL, Chen BT, et al. Impact of body mass index on radical cystectomy. J Urol. 2004;172:1281-1285. doi: 10.1097/01.ju.0000138785.48347.aa.
23. Carson CC III, Danneberger JE, Weinerth JL. Percutaneous lithotripsy in morbid obesity. J Urol. 1988;139:243-245. doi: 10.1016/s0022-5347(17)42375-5.
24. Soucy F, Ko R, Duvdevani M, et al. Percutaneous nephrolithotomy for staghorn calculi: a single center’s experience over 15 years. J Endourol. 2009; 23:1669–1673. doi: 10.1089/end.2009.1534.
25. Bagrodia A, Gupta A, Raman JD, Bensalah K, Pearle MS, Lotan Y. Impact of body mass index on cost and clinical outcomes after percutaneous nephrostolithotomy. Urology. 2008;72:756-60. doi: 10.1016/j.urology.2008.06.054.
26. Şimşek A, Özgör F, Akbulut MF, et al. Does body mass index effect the success of percutaneous nephrolithotomy? Turk J Urol. 2014;40:104-9. doi: 10.5152/tud.2014.66674.