Morbid obez hastalarda perkütan nefrolitotomi

Year 2016, Volume: 11 Issue: 2, 40 - 45, 01.05.2016

Berkan Şimşek Ahmet Bindayi Ahmet Tahra Uğur Boylu Eyüp Veli Küçük

Abstract

indeksi VKİ >35 kg/m2 perkütan nefrolitotomi PNL operasyonun etkinliğinin ve güvenilirliğin değerlendirilmesi ve normal kilolu VKİ = 18.5-25 kg/m2 hastalarla operasyonun sonuçlarının karşılaştırılması. Materyal ve Metod: Morbid obez ve normal kilolu hastalarda PNL operasyonun preoperatif, peroperatif ve postoperatif sonuçları retrospektif olarak değerlendirildi. 32 morbid obez ve 112 normal kilolu hasta değerlendirmeye alındı. Sonuçlar: Normal kilolu hasta grubunda yaş ortalaması 45.3 iken, morbid obez grubunda 42.6 idi. Morbid obez hasta grubunda diabetes mellitus %70.5 ile %7.1, p 0.05 . Yorum: Morbid obez hastalarda perkütan nefrolitotomi etkin ve güvenilir bir tedavi yöntemidir

Keywords

Obezite , böbrek taşı , perkütan nefrolitotomi

Percutaneous nephrolitotomy in morbidly obese patients

Abstract

Purpose: To evaluate the efficacy and safety of percutaneous nephrolithotomy PCNL in morbidly obese Body mass index BMI >35 kg/ m2 patients and compare the outcomes of the operation with normal weighted BMI = 18.5 – 25 kg/m2 patients. Material and Methods: We evaluated the perioperative and stone-related outcomes following PCNL in morbidly obese and normal weighted patients retrospectively. 32 morbidly obese and 112 normal weighted patients enrolled into this study. Results: Mean ages of normal weighted and morbidly obese patients were 45.3 and 42.6, respectively. The morbidly obese patients demonstrated higher rates of diabetes mellitus 70.5% vs. 7.1%, p < 0.05 and cardiovascular disease 47% vs. 3.5%, p < 0.05 . Mean stone dimesion in long axis was 2.3±0.9 cm. Mean operative duration was longer in the morbidly obese group 106 ±46 min vs. 78 ± 38.5 min, p =0.07 . Stone-free rates were similar between two groups 83.9% vs. 82.3%, p >0.05 . There was no significant difference in the transfusion rate and the length of hospital stay. There was no statistically significant difference between complication rates in two groups 9.8% vs. 8.8%, p >0.05 . Comment: Percutaneous nephrolitotomy is safe and effective procedure in morbidly obese patients.

Keywords

Obesity , kidney stone , percutaneous nephrolitotomy

References

• Alyami FA, Skinner TA, Norman RW. Impact of body mass index on clinical outcomes associated with percutaneous nephrolithotomy. Can Urol Assoc J 2013;7:197-201.
• Satman I, Yumuk VD, Erem C et al. Türk endokrinoloji ve metabolizma derneği(TEMD)- Obezite, Dislipidemi, Hi- pertansiyon Çalışma Grubu, Obezite Kılavuzu Hazırlama ve Düzenleme Komitesi, Obezite Tanı ve Tedavi Kılavuzu 2015.
• Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. JAMA 2003;289:187- 93.
• Thomas R, Cass AS. Extracorporeal shock wave lithotripsy in morbidly obese patients, J Urol. 1993;150:30-2.
• Taylor EN, Stampfer MJ, Curhan GC. Dietary factors and the risk of incident kidney stones in men: new insights after 14 years of follow-up, J Am Soc Nephrol 2004;15:3225-32.
• Fernström I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique, .Scand J Urol Nephrol 1976;10:257-9.
• Nasraway SA Jr, Albert M, Donnelly AM, Ruthazer R, Shikora SA, Saltzman E. Morbid obesity is an independent determinant of death among surgical critically ill patients, Crit Care Med 2006;34:964-70.
• Calvert RC, Burgess NA. Urolithiasis and obesity: metabolic and technical considerations, Curr Opin Urol 2005;15:113-7.
• Taylor EN, Curhan GC. Body size and 24-hour urine composition. Am J Kidney Dis 2006;48:905-15.
• Daudon M, Lacour B, Jungers P. Influence of body size on urinary stone composition in men and women. Urol Res 2006;34:193-9.
• Bensalah K, Raman JD, Bagrodia A, Marvin A, Lotan Y. Does obesity impact the costs of partial and radical nephrectomy?. J Urol 2008;179:1714-7.
• Carson CC III, Danneberger JE, Weinerth JL. Percutaneous lithotripsy in morbid obesity. J Urol 1988;139:243-5.
• El-Assmy AM, Shokeir AA, El-Nahas AR et al. Outcome of percutaneous nephrolithotomy: effect of body mass index. Eur Urol 2007;52:199-204.
• Koo BC, Burtt G, Burgess NA. Percutaneous stone surgery in the obese: outcome stratified according to body mass index. BJU Int 2004;93:1296-9.
• Chang SS, Duong DT, Wells N, Cole EE, Smith JA Jr, Cookson MS. Predicting blood loss and transfusion requirements during radical prostatectomy: the significant negative impact of increasing body mass index. J Urol 2004;171:1861-5.
• Fuller A, Razvi H, Denstedt JD et al. (CROES PCNL Study Group). The CROES percutaneous nephrolithotomy global study: the influence of body mass index on outcome. J Urol 2012;188:138-44.
• Oberg B, Poulsen TD. Obesity: an anaesthetic challenge, Acta Anaesthesiol Scand 1996;40:191-200.
• Brodsky JB, Oldroyd M, Winfield HN, Kozlowski PM. Morbid obesity and the prone position: a case report. J Clin Anesth 2001;13:138-40.
• Shoma AM, Eraky I, El-Kenawy MR, El-Kappany HA. Percutaneous nephrolithotomy in the supine position: technical aspects and functional outcome compared with the prone technique. Urology 2002;60:388-92.
• Kanaroglou A, Razvi H. Percutaneous nephrolithotomy under conscious sedation in morbidly obese patients. Can J Urol 2006;13:3153-5.
• El-Husseiny T, Moraitis K, Maan Z et al. Percutaneous endourologic procedures in high-risk patients in the lateral decubitus position under regional anesthesia, J Endourol 2009;23:1603-6.