Background and Purpose: To evaluate whether body mass index (BMI) has an impact on the outcomes of ultrasound-guided percutaneous nephrolithotomy (PCNL). Materials and Methods: The data of 359 patients who required PCNL at ShengJing hospital between June 2013 and July 2015 were reviewed, with the patients divided into 4 groups based on different ranges of BMI: <25, 25–29.9, 30–34.9, and ≥35 kg/m2. Baseline characteristics and outcomes were compared between the groups. Multivariable logistic regressions were used to evaluate the independent contribution of BMI as a predictor of outcomes. The Modified Clavien classification system was used for reporting complications. Results were compared between the groups using the chi-square and multivariate logistic regression tests. Results: No significant differences were noted in the demographic data between the 4 groups. Ultrasound screening time, total operative time, and hospital stay all increased with increasing BMI. No difference was found in the complication rate, stone free rate, or need for auxiliary procedures. Conclusion: Obesity does not increase the incidence of complications in ultrasound-guided PCNL, and the efficacy of the technique for obese patients is similar to that for normal weight patients. The lateral decubitus position was preferred in patients with higher BMI.

1.
Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al.; Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Body Mass Index). National, regional, and global trends in body-mass index since 1980:  -systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants.
Lancet
. 2011 Feb;377(9765):557–67.
2.
Kelly T, Yang W, Chen CS, Reynolds K, He J. Global burden of obesity in 2005 and projections to 2030.
Int J Obes
. 2008 Sep;32(9):1431–7.
3.
Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck C, Gallucci M, et al.; EAU/AUA Nephrolithiasis Guideline Panel. 2007 guideline for the management of ureteral calculi.
J Urol
. 2007 Dec;178(6):2418–34.
4.
Alyami FA, Skinner TA, Norman RW. Impact of body mass index on clinical outcomes associated with percutaneous nephrolithotomy.
Can Urol Assoc J
. 2013 Mar-Apr;7(3-4):E197–201.
5.
Koo BC, Burtt G, Burgess NA. Percutaneous stone surgery in the obese: outcome stratified according to body mass index.
BJU Int
. 2004 Jun;93(9):1296–9.
6.
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.
Eur Urol
. 2007 Jul;52(1):199–204.
7.
Tomaszewski JJ, Smaldone MC, Schuster T, Jackman SV, Averch TD. Outcomes of percutaneous nephrolithotomy stratified by body mass index.
J Endourol
. 2010 Apr;24(4):547–50.
8.
Sturm R. Increases in morbid obesity in the USA: 2000–2005.
Public Health
. 2007 Jul;121(7):492–6.
9.
Yan S, Xiang F, Yongsheng S. Percutaneous nephrolithotomy guided solely by ultrasonography: a 5-year study of [{GT}]700 cases.
BJU Int
. 2013 Nov;112(7):965–71.
10.
Thomas K, Smith NC, Hegarty N, Glass JM. The Guy’s stone score–grading the complexity of percutaneous nephrolithotomy procedures.
Urology
. 2011 Aug;78(2):277–81.
11.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.
Ann Surg
. 2004 Aug;240(2):205–13.
12.
Taylor EN, Stampfer MJ, Curhan GC. Obesity, weight gain, and the risk of kidney stones.
JAMA
. 2005 Jan;293(4):455–62.
13.
Calvert RC, Burgess NA. Urolithiasis and obesity: metabolic and technical considerations.
Curr Opin Urol
. 2005 Mar;15(2):113–7.
14.
Taylor EN, Curhan GC. Body size and 24-hour urine composition.
Am J Kidney Dis
. 2006 Dec;48(6):905–15.
15.
Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy.
Eur Urol
. 2007 Apr;51(4):899–906.
16.
Thomas R, Cass AS. Extracorporeal shock wave lithotripsy in morbidly obese patients.
J Urol
. 1993 Jul;150(1):30–2.
17.
Pareek G, Hedican SP, Lee FT Jr, Nakada SY. Shock wave lithotripsy success determined by skin-to-stone distance on computed tomography.
Urology
. 2005 Nov;66(5):941–4.
18.
Wheat JC, Roberts WW, Wolf JS Jr. Multi-session retrograde endoscopic lithotripsy of large renal calculi in obese patients.
Can J Urol
. 2009 Dec;16(6):4915–20.
19.
Nguyen TA, Belis JA. Endoscopic management of urolithiasis in the morbidly obese patient.
J Endourol
. 1998 Feb;12(1):33–5.
20.
Andreoni C, Afane J, Olweny E, Clayman RV. Flexible ureteroscopic lithotripsy: first-line therapy for proximal ureteral and renal calculi in the morbidly obese and superobese patient.
J Endourol
. 2001 Jun;15(5):493–8.
21.
Dash A, Schuster TG, Hollenbeck BK, Faerber GJ, Wolf JS Jr. Ureteroscopic treatment of renal calculi in morbidly obese patients: a stone-matched comparison.
Urology
. 2002 Sep;60(3):393–7.
22.
Aboumarzouk OM, Somani B, Monga M. Safety and efficacy of ureteroscopic lithotripsy for stone disease in obese patients: a systematic review of the literature.
BJU Int
. 2012 Oct;110(8b 8 Pt B):E374–80.
23.
Akman T, Binbay M, Ozgor F, Ugurlu M, Tekinarslan E, Kezer C, et al. Comparison of percutaneous nephrolithotomy and retrograde flexible nephrolithotripsy for the management of 2-4 cm stones: a matched-pair analysis.
BJU Int
. 2012 May;109(9):1384–9.
24.
Carson CC 3rd, Danneberger JE, Weinerth JL. Percutaneous lithotripsy in morbid obesity.
J Urol
. 1988 Feb;139(2):243–5.
25.
Zhou X, Sun X, Chen X, Gong X, Yang Y, Chen C, et al. Effect of Obesity on Outcomes of Percutaneous Nephrolithotomy in Renal Stone Management: A Systematic Review and Meta-Analysis.
Urol Int
. 2017;98(4):382–90.
26.
Usawachintachit M, Masic S, Chang HC, Allen IE, Chi T. Ultrasound Guidance to Assist Percutaneous Nephrolithotomy Reduces Radiation Exposure in Obese Patients.
Urology
. 2016 Dec;98:32–8.
27.
Wang K, Zhang P, Xu X, Fan M. Ultrasonographic versus Fluoroscopic Access for Percutaneous Nephrolithotomy: A Meta-Analysis.
Urol Int
. 2015;95(1):15–25.
28.
Shah AR, Glazebrook KN, Boughey JC, Hoskin TL, Shah SS, Bergquist JR, et al. Does BMI affect the accuracy of preoperative axillary ultrasound in breast cancer patients?
Ann Surg Oncol
. 2014 Oct;21(10):3278–83.
29.
Kritzer S, Magner K, Warshak CR. Increasing maternal body mass index and the accuracy of sonographic estimation of fetal weight near delivery.
J Ultrasound Med
. 2014 Dec;33(12):2173–9.
30.
Gofrit ON, Shapiro A, Donchin Y, Bloom AI, Shenfeld OZ, Landau EH, et al. Lateral decubitus position for percutaneous nephrolithotripsy in the morbidly obese or kyphotic patient.
J Endourol
. 2002 Aug;16(6):383–6.
31.
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 Sep;60(3):388–92.
32.
Manohar T, Jain P, Desai M. Supine percutaneous nephrolithotomy: effective approach to high-risk and morbidly obese patients.
J Endourol
. 2007 Jan;21(1):44–9.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.