Obesity in Percutaneous Nephrolithotomy. Is Body Mass Index Really Important?

Ortiz, Carlos Torrecilla; Martínez, Alcides Iván Meza; Morton, Anthony; Vila-Reyes, Helena; Feixas, Sergi Colom; Novo, J.F. Suárez; Miranda, Eladio Franco

doi:10.1016/j.urology.2014.03.062

Cited by 52 publications

(21 citation statements)

References 14 publications

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“…A number of mainly retrospective studies have evaluated PCNL outcomes in obese and morbidly obese patients, although to our knowledge there are no reports on outcomes in the super obese . Interestingly, the definition of morbid obesity varies, with some studies using BMI ≥ 35 kg/m 2 as the threshold and others using BMI ≥ 40 kg/m 2 .…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown that PCNL in the obese (BMI ≥ 30 kg/m 2 ) and morbidly obese has acceptable stone‐related outcomes with relatively low intra‐ and postoperative complications ; however, there can be substantial differences in the anatomy of an obese vs super obese patient, and such differences can render the standard PCNL instruments and techniques unfit for percutaneous stone removal in the latter. As obesity is already rampant in developed nations, and forecast to become a global epidemic in the near future, we anticipate an increased number of super obese patients with complex nephrolithiasis in need of treatment .…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous nephrolithotomy in super obese patients (body mass index ≥ 50 kg/m²): overcoming the challenges

et al. 2015

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ObjectiveTo analyse our experience with and the outcomes and lessons learned from percutaneous nephrolithotomy (PCNL) in the super obese (body mass index [BMI] ≥50 kg/m 2 ). Patients and MethodsIn this institutional review board approved study we retrospectively reviewed our PCNL database between July 2011 and September 2014 and identified all patients with a BMI ≥ 50 kg/m 2 . Patient demographics, peri-operative outcomes and complications were determined. Additionally, we identified a number of special PCNL considerations in the super obese that can maximize safe outcomes. ResultsA total of 21 PCNL procedures performed on 17 super obese patients were identified. The mean patient age was 54.8 years, the mean BMI was 57.2 kg/m 2 and the mean stone area was 1 037 mm 2 . Full staghorn stones were observed in six patients and partial staghorns in four patients. The mean operating time was 106 min and the mean haemoglobin decrease was 1.2 g/dL. The overall stone-free rate was 87%. There were four total complications: two Clavien grade II, one Clavien IIIb and one Clavien IVb. We identified several special considerations for safely preforming PCNL in the suber obese, including using extra-long nephroscopes and graspers, using custom-cut extra long access sheaths with suture 'tails' secured to easily retrieve the sheath, choosing the shortest possible access tract, readily employing flexible nephroscopes, placing nephroureteral tubes rather than nephrostomy tubes postoperatively, and meticulous patient positioning and padding. ConclusionWith appropriate peri-operative considerations and planning, PCNL is feasible and safe in the super obese. Stone clearance was similar to that reported in previous PCNL series in the morbidly obese, and is achievable with few complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Percutaneous nephrolithotomy in super obese patients (body mass index ≥ 50 kg/m²): overcoming the challenges

et al. 2015

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“…Prior publications evaluating fluoroscopy-guided PCNL have demonstrated no relationship between BMI and the rate of major postoperative adverse outcomes such as change in hemoglobin, hospital stay, stone-free rate, complication rate, and need for secondary procedures. 8,21–25 The clinical outcomes across BMI groups from our study for procedures performed under both ultrasonographic and fluoroscopic guidance were unchanged. One might expect more complications following PCNL in obese patients due to preoperative comorbidities and intraoperative challenges, but as we, and others, have shown, PCNL can be performed safely and effectively in obese patients.…”

Section: Discussionmentioning

confidence: 83%

“…Their prospective study of 255 PCNLs performed with fluoroscopic guidance demonstrated that total radiation dose increases along with BMI. 8 Torrecilla Ortiz et al’s study demonstrated an increased radiation dose with increasing BMI despite no significant difference in total fluoroscopic screening time among the BMI groups. Our present study showed the same trend to be the case for patients who underwent either US- or fluoroscopy-guided PCNL.…”

Section: Discussionmentioning

confidence: 94%

“…Compared to nonobese patients, obese patients are at risk for receiving 2–3 times the ionizing radiation exposure during fluoroscopy due to the higher radiation and energy required to produce the same image quality. 8,9 Surgeons and operating room staff are consequently exposed to higher radiation doses due to increased fluoroscopy time. Furthermore, the risk of exposure to the surgeon and staff may be even higher with obese patients due to increased radiation scatter with increasing tissue thickness.…”

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confidence: 99%

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Ultrasound Guidance to Assist Percutaneous Nephrolithotomy Reduces Radiation Exposure in Obese Patients

Usawachintachit

Masic

Chang

et al. 2016

Urology

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OBJECTIVE To evaluate the impact of body mass index (BMI) on perioperative outcomes and radiation exposure for ultrasound (US)-guided percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS Data were prospectively collected for consecutive patients who underwent PCNL at the University of California, San Francisco, from July 2013 to November 2015. Patients were divided into 3 groups according to their BMI: <25 (normal weight), 25–29.9 (overweight), and >30 (obese) kg/m2. Perioperative outcomes were compared between patients who underwent US-guided vs fluoroscopy-guided PCNL. RESULTS One hundred thirty-five patients were enrolled; 93 cases were performed under US and 42 under fluoroscopic guidance. US successfully guided renal access in 76.9% of normal weight, 79.0% of overweight, and 45.7% of obese patients (P < .05). Mean fluoroscopic screening time and radiation exposure dose were reduced for US compared to fluoroscopy cases across all BMI categories (P < .05). As BMI increased, radiation exposure dose rose disproportionately faster compared to screening time (P < .001). No significant differences among the BMI groups were found with regard to complication rate, hospital stay, and stone-free status. CONCLUSION US-guided PCNL may be more difficult in obese patients, but with its use, the overweight and obese experience the largest absolute reduction in radiation exposure. Because these patients are inherently at greater risk for radiation exposure compared to normal weight patients, they may benefit the most from adoption of US for PCNL.

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Percutaneous Nephrolithotomy Access Under Fluoroscopic Control

Bernardo

Silva²

2018

Smith's Textbook of Endourology

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Obesity in Percutaneous Nephrolithotomy. Is Body Mass Index Really Important?

Cited by 52 publications

References 14 publications

Percutaneous nephrolithotomy in super obese patients (body mass index ≥ 50 kg/m²): overcoming the challenges

Percutaneous nephrolithotomy in super obese patients (body mass index ≥ 50 kg/m²): overcoming the challenges

Ultrasound Guidance to Assist Percutaneous Nephrolithotomy Reduces Radiation Exposure in Obese Patients

Percutaneous Nephrolithotomy Access Under Fluoroscopic Control

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Obesity in Percutaneous Nephrolithotomy. Is Body Mass Index Really Important?

Cited by 52 publications

References 14 publications

Percutaneous nephrolithotomy in super obese patients (body mass index ≥ 50 kg/m2): overcoming the challenges

Percutaneous nephrolithotomy in super obese patients (body mass index ≥ 50 kg/m2): overcoming the challenges

Ultrasound Guidance to Assist Percutaneous Nephrolithotomy Reduces Radiation Exposure in Obese Patients

Percutaneous Nephrolithotomy Access Under Fluoroscopic Control

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Percutaneous nephrolithotomy in super obese patients (body mass index ≥ 50 kg/m²): overcoming the challenges

Percutaneous nephrolithotomy in super obese patients (body mass index ≥ 50 kg/m²): overcoming the challenges