Supin ve pron perkütan nefrolitotomi: obez hastalarda etkinlik ve güvenlik karşılaştırması

Yıl 2022, , 49 - 56, 30.09.2022

Taner Kargı , Mithat Ekşi , Ubeyd Sungur , Osman Özdemir , Serdar Karadağ , İsmail Evren , Ahmet Haciislamoğlu , Hakan Polat , Feyzi Arda Atar , Alper Bitkin , Ali İhsan Taşçı

https://doi.org/10.54233/endouroloji.1135843

Öz

Amaç: Obez hastalarda supin ve pron perkütan nefrolitotomiyi (PNL) etkinlik ve güvenlik açısından karşılaştırmak.
Gereç ve Yöntemler: Ocak 2011 ile Eylül 2020 tarihleri arasında Dünya Sağlık Örgütü (WHO) vücut kitle indeksi (VKİ) ≥30 kg/m2 sınıflamasına göre 2 cm’den büyük böbrek taşı olan, supin veya pron pozisyonda PNL uygulanan hastalar retrospektif olarak çalışmaya dahil edildi. Demografik özellikler, intraoperatif, postoperatif veriler ile birlikte Modifiye Clavien Derecelendirme Sistemine göre komplikasyonlar listelendi. Hastalar taşsızlık durumu belgelenerek 3 ay boyunca takip edildi.
Bulgular: Toplam 156 obez hastanın 74’üne (%47,4) supin PNL (grup 1) ve 82’sine (%52,6) pron PNL (grup 2) uygulandı. Hemoglobin düşüşü pelvikalisiyel akses sayısı, kan transfüzyonu, hastanede kalış süresi, komplikasyon oranları, taşsızlık durumu açısından gruplar arasında istatistiksel olarak anlamlı fark yoktu (p>0.05). Pelvikalisiyel akses yeri (üst, orta, alt kaliksler) iki grup arasında anlamlı olarak farklıydı (grup 1’de sırasıyla %18,9, %32,4, %42,6, grup 2’de %3,2, %19,3, %77,5) (p<0,001). Ortalama ameliyat süreleri gruplar arasında istatistiksel olarak farklı saptandı (sırasıyla grup 1’de 97,2 ± 18,1 dakika, grup 2’de 119,5 ± 18,9 dakika) (p<0,001).
Sonuç: PNL, hem supin hem de pron pozisyonda uygulanabilen obez hastalarda böbrek taşlarının tedavisinde güvenli ve etkili bir yöntemdir. Hasta karakteristiği göz önünde bulundurularak, supin pozisyonda üst kaliksten erişim de tercih edilebilir. Ek olarak, supin pozisyonun pron pozisyona göre en büyük avantajı daha kısa ameliyat süresine sahip olmasıdır.

Anahtar Kelimeler

perkütan nefrolitotomi, obez, supin, pron

Supine versus prone percutaneous nephrolithotomy: A comparison of efficacy and safety in obese patients

Öz

Objective: To compare prone and supine percutaneous nephrolithotomy (PNL) in obese patients with respect to efficacy and safety.
Material and Methods:  Individuals with kidney stones larger than 2 cm undergoing either prone or supine position PNL were included in the study based on the World Health Organization (WHO) classification of body mass index (BMI) ≥30 kg/m2 between January 2011 and September 2020 retrospectively. Demographic characteristics, intraoperative, postoperative data, and complications according to Modified Clavien Grading System were listed. Patients were followed for 3 months, documenting their stone-free status. 
Results: Out of the total 156 obese patients, 74(47.4%) underwent supine PNL (group 1), and 82 (52.6%) were prone to PNL (group 2). There was no statistically significant difference between the groups concerning hemoglobin drop, the number of pelvicalyceal access, blood transfusion, length of hospital stay, complications rates, and stone-free status (p>0.05). The location of pelvicalyceal access (upper, middle, lower calyces) was significantly different (18.9%, 32.4%, 42.6% in group 1, 3.2%, 19.3%, 77.5% in group 2, respectively) (p<0.001). Mean operative times were statistically different between the groups (97.2 ± 18.1 minutes in group 1, 119.5 ± 18.9 minutes in group 2, respectively) (p<0.001).
Conclusion: In the prone or supine position, PNL is a safe and effective method for managing kidney stones in obese patients. Access through the upper calyx may be favored in the supine position considering to patient’s characteristics. Additionally, the supine position has the greatest advantage over the prone position due to shorter operative times.

Anahtar Kelimeler

percutaneous nephrolithotomy, obese, supine, prone

Kaynakça

• GBD 2015 Obesity Collaborators, Afshin A, Forouzanfar MH, et al. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med. 2017;377:13-27. https://doi.org/10.1056/NEJMoa1614362
• Singh NP, Boyd CJ, Poore W, et al. Obesity and Kidney Stone Procedures. Rev Urol. 2020;22:24-29.
• Carbone A, Al Salhi Y, Tasca A, et al. Obesity and kidney stone disease: a systematic review. Minerva Urol Nefrol. 2018;70:393-400. https://doi.org/10.23736/S0393-2249.18.03113-2
• Asplin JR. Obesity and urolithiasis. Adv Chronic Kidney Dis. 2009;16:11-20. https://doi.org/10.1053/j.ackd.2008.10.003
• Taylor EN, Stampfer MJ, Curhan GC. Obesity, weight gain, and the risk of kidney stones. JAMA. 2005;293:455-62. https://doi.org/10.1001/jama.293.4.455
• EAU Guidelines on Urolithiasis 2021. Eur Assoc Guidel 2021 Ed. 2021; https://uroweb.org/guideline/urolithiasis/#3. (Accessed on 1/1/2022).
• Ozgor F, Ucpinar B, Binbay M. Effect of Obesity on Prone Percutaneous Nephrolithotomy Outcomes: A Systemic Review. Urol J. 2016;13:2471-8.
• Zhou X, Sun X, Chen X, et al. Effect of Obesity on Outcomes of Percutaneous Nephrolithotomy in Renal Stone Management: A Systematic Review and Meta-Analysis. Urol Int. 2017;98:382-390. https://doi.org/10.1159/000455162
• Patel RM, Okhunov Z, Clayman RV, et al. Prone Versus Supine Percutaneous Nephrolithotomy: What Is Your Position? Curr Urol Rep. 2017;18:26. https://doi.org/10.1007/s11934-017-0676-9
• 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. https://doi.org/10.5152/tud.2014.66674
• 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. https://doi.org/10.5489/cuaj.11229
• Desoky E, Abd Elwahab KM, El-Babouly IM, et al. Outcomes of Flank-Free Modified Supine Percutaneous Nephrolithotomy Based on BMI. Urol Int. 2021;105:77-82. https://doi.org/10.1159/000511292
• Ferreira TAC, Dutra MMG, Vicentini FC, et al. Impact of Obesity on Outcomes of Supine Percutaneous Nephrolithotomy. J Endourol. 2020;34:1219-1222. https://doi.org/10.1089/end.2020.0576
• Scoffone CM, Cracco CM, Cossu M, et al. Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: a new standard for percutaneous nephrolithotomy? Eur Urol. 2008;54:1393-403. https://doi.org/10.1016/j.eururo.2008.07.073
• Pricop C, Radavoi GD, Puia D, et al. Obesity: A Delicate Issue Choosing The Eswl Treatment For Patients With Kidney And Ureteral Stones ? Acta Endocrinol (Buchar). 2019;5:133-138. https://doi.org/10.4183/aeb.2019.133
• Javanmard B, Razaghi MR, Ansari Jafari A, et al. Flexible Ureterorenoscopy Versus Extracorporeal Shock Wave Lithotripsy for the Treatment of Renal Pelvis Stones of 10-20 mm in Obese Patients. J Lasers Med Sci. 2015;6:162-6. https://doi.org/10.15171/jlms.2015.12
• Chen HQ, Chen ZY, Zeng F, et al. Comparative study of the treatment of 20-30 mm renal stones with miniaturized percutaneous nephrolithotomy and flexible ureterorenoscopy in obese patients. World J Urol. 2018;36:1309-1314. . https://doi.org/10.1007/s00345-018-2258-y
• Xu C, Song R, Lu P, et al. A retrospective study comparing super-mini percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of 20-30 mm renal stones in obese patients. PeerJ. 2020;8:8532. https://doi.org/10.7717/peerj.8532
• Shohab D, Ayub R, Alam MU, et al. Effect of body mass index on operative time, hospital stay, stone clearance, postoperative complications, and postoperative analgesic requirement in patients undergoing percutaneous nephrolithotomy. Turk J Urol. 2015;41:177-80. https://doi.org/10.5152/tud.2015.61482
• Isoglu CS, Suelozgen T, Boyacioglu H, et al. Effects of body mass index on the outcomes of percutaneous nephrolithotomy. Int Braz J Urol. 2017;43:698-703. https://doi.org/10.1590/S1677-5538.IBJU.2016.0678
• Keller EX, DE Coninck V, Proietti S, et al. European Association of Urology - European Society of Residents in Urology (EAU-ESRU). Prone versus supine percutaneous nephrolithotomy: a systematic review and meta-analysis of current literature. Minerva Urol Nephrol. 2021;73:50-58. https://doi.org/10.23736/S2724-6051.20.03960-0