Does the Metabolic Syndrome or Its Components Affect the Outcome of Percutaneous Nephrolithotomy?

Tefekli̇, Ahmet; Kurtoğlu, Hi̇lal; Tepeler, Kadir; Karadağ, Mert Ali; Kandıralı, Engin; Sarı, Esin Söğütlü; Baykal, Murat; Müslümanoğlu, Ahmet Yaser

doi:10.1089/end.2007.0034

Cited by 56 publications

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“…Tefekli et al [ 5 ] reported a 9.5% incidence rate for patients with metabolic syndrome undergoing PCNL; they also reported an overall success rate of 96.3% for PCNL and a complication rate of 11.4%. They detected that the risk of major complications was 2.5-times higher in patients with hypertension, 2.7-times higher in patients with DM, and 2.45-times higher in patients with metabolic syndrome [ 5 ] . In their study, the need for auxiliary treatments after PCNL was more common in patients with DM and the metabolic syndrome, but not in those with a BMI of > 30 kg/m 2 and serum lipid abnormalities.…”

Section: Discussionmentioning

confidence: 99%

“…They detected that the risk of major complications was 2.5-times higher in patients with hypertension, 2.7-times higher in patients with DM, and 2.45-times higher in patients with metabolic syndrome [ 5 ] . In their study, the need for auxiliary treatments after PCNL was more common in patients with DM and the metabolic syndrome, but not in those with a BMI of > 30 kg/m 2 and serum lipid abnormalities.…”

Section: Discussionmentioning

confidence: 99%

“…However, in patients with metabolic syndrome, only a few studies have investigated the effi cacy and safety of PCNL treatment [ 5 ] . Furthermore, studies reporting long-term results of PCNL in metabolic syndrome are lacking.…”

Section: Introductionmentioning

confidence: 99%

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The impact of metabolic syndrome on long‐term outcomes of percutaneous nephrolithotomy (PCNL)

et al. 2012

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E 1 0 7 9What ' s known on the subject? and What does the study add? The presence of metabolic syndrome is associated with development of kidney stones and an increase in the stone-recurrence rate. However, studies reporting long-term results of percutaneous nephrolithotomy (PCNL) in metabolic syndrome are lacking.The present study showed that metabolic syndrome was associated with worsening renal function at long-term follow-up and the stone-recurrence rate recurrence after PCNL in patients with metabolic syndrome was 3.2-fold higher compared with the control group. OBJECTIVE• To investigate the impact of metabolic syndrome on long-term kidney function and stone recurrence rates after percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS• In all, 73 patients with metabolic syndrome who underwent stone analysis and had a minimum follow-up of 12 months after PCNL were reviewed.• In addition, 73 patients without any metabolic syndrome components who had undergone PCNL and were followed-up for at least 12 months were included in the study as the control group.• These control group patients were selected from 226 patients who were matched with the patients with metabolic syndrome using a 1 : 1 ratio. The matching parameters were age, gender and stone size. RESULTS• Stone analyses showed that calcium oxalate monohydrate (52.0%) and uric acid (21.9%) were most common among patients with metabolic syndrome, whereas calcium oxalate monohydrate (76.7%) was the most common stone type in the control group.• Stone recurrences occurred with a mean ( SD , range) of 36.1 (21.3, 12 -109) months follow-up in 26 patients (41.9%) and 12 patients (18.9%) in the metabolic syndrome and control groups, respectively ( P = 0.003).• While estimated glomerular fi ltration rate was decreased from 87.8 to 66.6 mL/ min/1.73 m 2 in the metabolic syndrome group, it changed from 96.4 to 91.2 mL/ min/1.73 m 2 in control group at long-term follow-up. CONCLUSIONS• The most frequent stone type was calcium oxalate monohydrate in patients with or without metabolic syndrome.• In patients with metabolic syndrome who underwent PCNL, the stone recurrence rate was > 40%.• Metabolic syndrome is associated with worsening renal function at long-term follow-up. KEYWORDS INTRODUCTIONMetabolic syndrome is a chronic disease with components of obesity, insulin resistance, hypertension, impaired glucose tolerance, hyperinsulinaemia and dyslipidaemia; this disease is also associated with an increased risk for cardiovascular disease, type 2 diabetes mellitus (DM) and urolithiasis [ 1 ] . The prevalence of metabolic syndrome is 24% in men and 23.4% in women in the USA [ 2 ] . There is also strong evidence that obesity, weight gain, and DM are risk factors for the development of kidney stones and increase the stone recurrence rate [ 3 ] . A large series reported that the presence of metabolic syndrome was associated with a ≈ two-fold increase in the odds of self-reported kidney stone disease [ 4 ] .Percutaneous nephrolithotomy (PCNL) plays an important role in th...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The impact of metabolic syndrome on long‐term outcomes of percutaneous nephrolithotomy (PCNL)

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“…Hypertension and diabetes mellitus are two patient-related independent predictive factors affecting bleeding risk [6,28,29]. The authors exploring the factors affecting blood loss during PNL concluded that complex renal stones requiring multiple renal tracts are associated with high transfusion rates [6,26,28,30].…”

Section: Discussionmentioning

confidence: 99%

Parenchymal Thickness: Does It Have an Impact on Outcomes of Percutaneous Nephrolithotomy?

et al. 2013

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Objective: To evaluate whether renal parenchymal thickness (RPT) has an effect on the outcomes of percutaneous nephrolithotomy (PNL). Methods: We performed a retrospective analysis of 144 patients with lower pole and/or renal pelvic stones who underwent PNL. The relationship between RPT and peri- and postoperative measures was evaluated. Results: The average age was 45.94 ± 14.47 (15-76) years. The mean BMI was calculated as 27.47 ± 4.73 (16.9-44.9) kg/m². The mean stone burden was 293 ± 126 (150-800 mm²). The mean RPT was measured as 17.33 ± 5.32 (6-35) mm. No correlation was detected between the RPT and the operation or fluoroscopy times or the duration of hospitalization (p = 0.63, 0.52, 0.08, respectively). The mean drop in hemoglobin level was 1.45 ± 1.25 (0-9) g/dl. A negative correlation was detected between hemoglobin drop and RPT (p = 0.01, r = -0.23). However, the RPT was similar in patients who did or did not require a blood transfusion (p = 0.09). The RPT was found to have no impact on success rate (p = 0.4). Conclusion: The postoperative hemoglobin drop increases in parallel with the increase in RPT. However, no relationship was detected between the RPT and blood transfusion, overall success rate or any other perioperative parameters.

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“…[16][17][18] In a series of 183 diabetic patients who underwent percutaneous nephrolithotomy, Duvdevani and colleagues 16 found that uric acid was the most common stone composition and that these patients had a longer hospital stay than non-diabetics. Surgical time, complications and stone-free rates were not significantly different from those observed in the non-diabetic group.…”

Section: Discussionmentioning

confidence: 99%

A comparison of the metabolic profiles of diabetic and non-diabetic uric acid stone formers

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Al-Bareeq

et al. 2012

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E190Cite as: Can Urol Assoc J 2013;7:E190-2. http://dx.doi.org/10.5489/cuaj.11133 Epub 2012 Mar 2. AbstractIntroduction: The aim of this study was to compare the metabolic profiles of diabetic and non-diabetic patients with uric acid stones to understand whether preventive strategies should be tailored to reflect different causative factors. Methods:The results of the metabolic evaluation of patients with uric acid stones identified prospectively from the Metabolic Stone Clinic at St. Joseph's Hospital, London, Canada were reviewed. Information included patients' clinical histories, 24 hour urine collections, blood chemistry and stone analysis. Results: Complete data were obtained from 68 patients with uric acid stones. Twenty-two patients had diabetes. There were no statistically significant differences in mean age, body mass index, or history of gout. Among diabetics, pure uric acid stones were identified in 14 patients (63%) and mixed uric acid in 8 (36%). Pure uric acid stones were more common in the diabetic cohort (63% vs. 46%, p = 0.16). Urine pH, serum and urine uric acid levels and 24-hour urine volumes were similar in both groups. The diabetic group had an increased average oxalate excretion (424 μmol/d vs. 324 μmol/d, p = 0.003). Conclusion:The exact etiological basis for the higher oxalate excretion in diabetic uric acid stone formers is unclear. Whether this is a metabolic feature of diabetes, due to dietary indiscretion or the iatrogenic consequence of dietary advice requires further investigation.

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Does the Metabolic Syndrome or Its Components Affect the Outcome of Percutaneous Nephrolithotomy?

Abstract: Our results indicate that the metabolic syndrome and its components (DM and HT) significantly augment auxiliary treatment and complication rates after PCNL.

Cited by 56 publications

References 24 publications

The impact of metabolic syndrome on long‐term outcomes of percutaneous nephrolithotomy (PCNL)

The impact of metabolic syndrome on long‐term outcomes of percutaneous nephrolithotomy (PCNL)

Parenchymal Thickness: Does It Have an Impact on Outcomes of Percutaneous Nephrolithotomy?

A comparison of the metabolic profiles of diabetic and non-diabetic uric acid stone formers

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