Evaluation of the Impact of Body Mass Index on the Outcomes of Supine Percutaneous Nephrolithotomy

Year 2024, Volume: 19 Issue: 3, 121 - 128, 30.10.2024

Ender Cem Bulut , Burak Elmas , Bora Küpeli

https://doi.org/10.33719/nju1534944

Abstract

Objective: This study aimed to evaluate the impact of obesity on the outcomes of supine percutaneous nephrolithotomy (PCNL) in a tertiary care center. Understanding surgical outcomes in obese patients, given their rising prevalence and urolithiasis risk, is crucial for optimizing treatment strategies.
Materials and Methods: This retrospective study included data from 256 patients aged 18 and older who underwent PCNL in the Galdakao-Valdivia position between July 2021 and July 2024 at a tertiary care hospital. Patients were categorized into three groups based on their body mass index (BMI): normal weight (BMI: 18-24.9 kg/m²), overweight (BMI: 25-29.9 kg/m²), and obese (BMI: 30-34.9 kg/m²). Demographic data, stone characteristics, operative time, fluoroscopy time, hospital stay, nephrostomy duration, stone-free rates (SFR), and complications were analyzed and compared across the three groups.
Results: There was no significant difference between the groups regarding age, sex, stone laterality, location, or size (p>0.05). Median BMI values were significantly different between the groups (p<0.001). The stone-free rates were 79.2%, 77%, and 75% for the normal, overweight, and obese groups, respectively (p>0.05). No significant differences were found in operative time, fluoroscopy time, hospital stay, or nephrostomy time among the groups (p>0.05). Minor and major complication rates were similar across all groups (p>0.05).
Conclusion: Obesity does not appear to significantly impact the outcomes of supine PCNL, including operative time, stone-free rates, or complication rates. These findings suggest that with experienced surgeons, supine PCNL is a safe and effective treatment option for obese patients, though further prospective studies are needed to confirm these results.

Keywords

supine percutaneous nephrolithotomy, kidney stone, obesity, body mass index

Ethical Statement

This study was reviewed and approved by the Ethics Committee of Gazi University on 30 July 2024 (approval number 1268).

Vücut Kitle İndeksinin Supin Perkütan Nefrolitotomi Sonuçları Üzerindeki Etkisinin Değerlendirilmesi

Abstract

Özet
Amaç: Bu çalışma, obezitenin üçüncü basamak bir sağlık merkezinde supin perkütan nefrolitotomi (PCNL) sonuçları üzerindeki etkisini değerlendirmeyi amaçlamaktadır. Obez hastalardaki cerrahi sonuçların anlaşılması, artan prevalansları ve ürolitiyazis riski göz önüne alındığında, tedavi stratejilerinin optimize edilmesi için kritik öneme sahiptir.
Materyal-Metot: Bu retrospektif çalışma, Temmuz 2021 ile Temmuz 2024 tarihleri arasında üçüncü basamak bir hastanede Galdakao-Valdivia pozisyonunda PCNL uygulanan 18 yaş ve üzeri 256 hastanın verilerini içermektedir. Hastalar, beden kitle indeksine (BMI) göre normal kilolu (BMI: 18-24.9 kg/m²), aşırı kilolu (BMI: 25-29.9 kg/m²) ve obez (BMI: 30-34.9 kg/m²) olmak üzere üç gruba ayrıldı. Demografik veriler, taş özellikleri, ameliyat süresi, floroskopi süresi, hastanede kalış süresi, nefrostomi süresi, taşsızlık oranları (SFR) ve komplikasyonlar gruplar arasında analiz edilerek karşılaştırıldı.
Bulgular: Gruplar arasında yaş, cinsiyet, taş tarafı, yeri veya boyutu açısından anlamlı bir fark bulunmadı (p>0.05). Gruplar arasında median BMI değerleri açısından anlamlı bir fark vardı (p<0.001). Taşsızlık oranları sırasıyla normal kilolu, aşırı kilolu ve obez gruplarda %79.2, %77 ve %75 olarak bulundu (p>0.05). Operasyon süresi, floroskopi süresi, hastanede kalış süresi veya nefrostomi süresi açısından gruplar arasında anlamlı bir fark bulunmadı (p>0.05). Minör ve majör komplikasyon oranları tüm gruplarda benzerdi (p>0.05).
Sonuç: Obezitenin, supin PCNL sonuçları üzerinde operasyon süresi, taşsızlık oranları veya komplikasyon oranları gibi faktörler açısından önemli bir etkisi olmadığı görülmektedir. Bu bulgular, deneyimli cerrahlar tarafından gerçekleştirildiğinde, supin PCNL'nin obez hastalar için güvenli ve etkili bir tedavi seçeneği olduğunu düşündürmektedir. Ancak, bu sonuçların doğrulanması için daha geniş hasta popülasyonları ile yapılacak prospektif çalışmalara ihtiyaç vardır.

Keywords

supin perkütan nefrolitotomi, böbrek taşı, obezite, vücut kitle indeksi

Ethical Statement

Bu çalışma Gazi Üniversitesi Etik Kurulu tarafından 30 Temmuz 2024 tarihinde incelenerek onaylanmıştır (onay numarası: 1268).

References

• 1. Wang W, Fan J, Huang G, Li J, Zhu X, Tian Y, et al. Prevalence of kidney stones in mainland China: a systematic review. Scientific reports. 2017;7(1):41630. https://doi.org/10.1038/srep41630
• 2. Seitz C, Desai M, Häcker A, Hakenberg OW, Liatsikos E, Nagele U, et al. Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy. European urology. 2012;61(1):146- 58. https://doi.org/10.1016/j.eururo.2011.09.016
• 3. Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, et al. Surgical management of stones: American urological association/endourological society guideline, PART I. The Journal of urology. 2016;196(4):1153-60. https://doi.org/10.1016/j. juro.2016.05.090
• 4. EAU. EAU Guidelines; Edn. presented at the EAU Annual Congress Paris 2024; EAU Guidelines Office: Arnhem, The Netherlands, 2024; ISBN 978-94-92671- 23-3.
• 5. Jiang Y, He L, Luo G, Zhang X. Prevalence of kidney stones and associated risk factors in the Shunyi District of Beijing, China. Hong Kong Medical Journal. 2017;23(5):462. https://doi.org/10.12809/hkmj164904
• 6. Romero V, Akpinar H, Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Reviews in urology. 2010;12(2-3):e86.
• 7. Moe OW. Kidney stones: pathophysiology and medical management. The lancet. 2006;367(9507):333-44. https://doi.org/10.1016/S0140-6736(06)68071-9
• 8. Jaacks LM, Vandevijvere S, Pan A, McGowan CJ, Wallace C, Imamura F, et al. The obesity transition: stages of the global epidemic. The lancet Diabetes & endocrinology. 2019;7(3):231-40. https://doi. org/10.1016/S2213-8587(19)30026-9
• 9. Xu Y, Huang X. Effect of body mass index on outcomes of percutaneous nephrolithotomy: a systematic review and meta-analysis. Frontiers in Surgery. 2022;9:922451. https://doi.org/10.3389/fsurg.2022.922451
• 10. Burns H, Ahmad N, Hendry J, Nalagatla S. Does body mass index impact the efficacy and complication rate of mini-percutaneous nephrolithotomy? Journal of Clinical Urology. 2021;14(2):120-4. https://doi.org/10.1177/2051415820936887
• 11. Fuller A, Razvi H, Denstedt JD, Nott L, Pearle M, Cauda F, et al. The CROES percutaneous nephrolithotomy global study: the influence of body mass index on outcome. The Journal of urology. 2012;188(1):138-44. https://doi.org/10.1016/j.juro.2012.03.013
• 12. Alyami FA, Skinner TA, Norman RW. Impact of body mass index on clinical outcomes associated with percutaneous nephrolithotomy. Canadian Urological Association Journal. 2013;7(3-4):E197. https://doi. org/10.5489/cuaj.11229
• 13. Apovian CM. Obesity: definition, comorbidities, causes, and burden. Am J Manag Care. 2016;22(7 Suppl):s176-85.
• 14. Neeland IJ, Poirier P, Després J-P. Cardiovascular and metabolic heterogeneity of obesity: clinical challenges and implications for management. Circulation. 2018;137(13):1391-406. https://doi.org/10.1161/ CIRCULATIONAHA.117.029617
• 15. Nasraway Jr SA, Albert M, Donnelly AM, Ruthazer R, Shikora SA, Saltzman E. Morbid obesity is an independent determinant of death among surgical critically ill patients. Critical care medicine. 2006;34(4):964-70. https://doi.org/10.1097/01.CCM.0000205758.18891.70
• 16. Unruh KR, Bastawrous AL, Kaplan JA, Moonka R, Rashidi L, Simianu VV. The impact of obesity on minimally invasive colorectal surgery: a report from the Surgical Care Outcomes Assessment Program collaborative. The American Journal of Surgery. 2021;221(6):1211-20. https://doi.org/10.1016/j. amjsurg.2021.03.019
• 17. Goyal A, Elminawy M, Kerezoudis P, Lu VM, Yolcu Y, Alvi MA, et al. Impact of obesity on outcomes following lumbar spine surgery: a systematic review and meta-analysis. Clinical neurology and neurosurgery. 2019;177:27-36. https://doi.org/10.1016/j. clineuro.2018.12.012
• 18. Thomas R, Cass AS. Extracorporeal shock wave lithotripsy in morbidly obese patients. The Journal of urology. 1993;150(1):30-2. https://doi.org/10.1016/ s0022-5347(17)35389-2
• 19. El-Assmy AM, Shokeir AA, El-Nahas AR, Shoma AM, Eraky I, El-Kenawy MR, et al. Outcome of percutaneous nephrolithotomy: effect of body mass index. European urology. 2007;52(1):199-205. https://doi.org/10.1016/j. eururo.2006.11.049
• 20. Carson III CC, Danneberger JE, Weinerth JL. Percutaneous lithotripsy in morbid obesity. The Journal of urology. 1988;139(2):243-5. https://doi.org/10.1016/ s0022-5347(17)42375-5
• 21. Dauw CA, Borofsky MS, York N, Lingeman JE. Percutaneous nephrolithotomy in the superobese: A comparison of outcomes based on body mass index. Journal of endourology. 2016;30(9):987-91. https://doi.org/10.1089/end.2016.0437
• 22. Slade A, Large T, Sahm E, Rivera M. Mini-percutaneous nephrolithotomy outcomes in the obese population: a retrospective review. Journal of Endourology. 2023;37(6):623-7. https://doi.org/10.1089/end.2022.0749
• 23. Gonulalan U, Akand M, Coban G, Cicek T, Kosan M, Goktas S, et al. Skin-to-stone distance has no impact on outcomes of percutaneous nephrolithotomy. Urologia Internationalis. 2014;92(4):444-8. https://doi.org/10.1159/000356562
• 24. Sergeyev I, Koi PT, Jacobs SL, Godelman A, Hoenig DM. Outcome of percutaneous surgery stratified according to body mass index and kidney stone size. Surgical Laparoscopy Endoscopy & Percutaneous Techniques. 2007;17(3):179-83. https://doi.org/10.1097/ SLE.0b013e318051543d
• 25. Iqbal N, Hasan A, Razzaq S, Rashid FS. Effect of Body Mass Index on complications and success rates of percutaneous nephrolithotomy-A tertiary care hospital experience. Pakistan Journal of Medical Sciences. 2022;38(8):2112. https://doi.org/10.12669/ pjms.38.8.3663
• 26. Ferreira TAC, Dutra MMG, Vicentini FC, Szwarc M, Mota PKV, Eisner B, et al. Impact of obesity on outcomes of supine percutaneous nephrolithotomy. Journal of Endourology. 2020;34(12):1219-22. https:// doi.org/10.1089/end.2020.0576
• 27. Ozgor F, Yanaral F, Savun M, Ozdemir H, Sarilar O, Binbay M. Comparison of STONE, CROES and Guy’s nephrolithometry scoring systems for predicting stonefree status and complication rates after percutaneous nephrolithotomy in obese patients. Urolithiasis. 2018;46:471-7. https://doi.org/10.1007/s00240-017-1003- 0
• 28. 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(4):756-60. https://doi.org/10.1016/j. urology.2008.06.054
• 29. Calvert RC, Burgess NA. Urolithiasis and obesity: metabolic and technical considerations. Current opinion in urology. 2005;15(2):113-7. https://doi. org/10.1097/01.mou.0000160626.36236.22
• 30. Öztürk H. Gastrointestinal system complications in percutaneous nephrolithotomy: a systematic review. Journal of Endourology. 2014;28(11):1256-67. https:// doi.org/10.1089/end.2014.0344