Objective: Skin-to-stone distance (SSD) is a stronger factor than body mass index in predicting the success of shock wave lithotripsy. We aimed to evaluate the impact of SSD on outcomes of percutaneous nephrolithotomy (PCNL). Materials and Methods: The medical records of 1,280 patients who had undergone PCNL between April 2007 and February 2012 were evaluated retrospectively. 192 patients who had had preoperative non-contrasted computed tomography and single renal access were included the study. According to this median SSD value, patients were divided into two groups: group 1 (SSD ≤94 mm) (n = 92) and group 2 (SSD >94 mm) (n = 90). The groups were compared according to operative and postoperative parameters. Results: We found no significant differences between the two groups with regard to stone-free rate, operation time, fluoroscopy time, hospitalization time, visual analog score of pain, stone burden, transfusion rates and complication rates. On the other hand, the mean body mass index of group 1 was significantly lower than that of group 2 (p < 0.05). Conclusions: In this retrospective review of patients undergoing PCNL, we found that SSD has no impact on operative and postoperative outcomes. These results were in accordance with the safety of PCNL in obese patients.

1.
Fernström I, Johansson B: Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol 1976;10:257-259.
2.
Tiselius HG, Ackermann D, Alken P, et al: Guidelines on Urolithiasis. Arnhem, European Association of Urology, 2007.
3.
Deane LA, Clayman RV: Advances in percutaneous nephrostolithotomy. Urol Clin North Am 2007;34:383-395.
4.
Thomas R, Cass AS: Extracorporeal shock wave lithotripsy in morbidly obese patients. J Urol 1993;150:30-32.
5.
Fuller A, Razvi H, Denstedt JD, Nott L, Pearle M, Cauda F, Bolton D, Celia A, de la Rosette J; CROES PCNL Study Group: The CROES percutaneous nephrolithotomy global study: the influence of body mass index on outcome. J Urol 2012;188:138-144.
6.
El-Assmy AM, Shokeir AA, El-Nahas AR, Shoma AM, Eraky I, El-Kenawy MR, El-Kappany HA: Outcome of percutaneous nephrolithotomy: effect of body mass index. Eur Urol 2007;52:199-204.
7.
Tepeler A, Binbay M, Akman T, Erbin A, Kezer C, Silay MS, Yuruk E, Kardas S, Akcay M, Armagan A, Muslumanoglu AY: Parenchymal thickness: does it have an impact on outcomes of percutaneous nephrolithotomy? Urol Int 2013;90:405-410.
8.
Park BH, Choi H, Kim JB, Chang YS: Analyzing the effect of distance from skin to stone by computed tomography scan on the extracorporeal shock wave lithotripsy stone-free rate of renal stones. Korean J Urol 2012;53:40-43.
9.
Perks AE, Schuler TD, Lee J, Ghiculete D, Chung DG, D'A Honey RJ, Pace KT: Stone attenuation and skin-to-stone distance on computed tomography predicts for stone fragmentation by shock wave lithotripsy. Urology 2008;72:765-769.
10.
Pareek G, Hedican SP, Lee FT, Nakada SY: Shock wave lithotripsy success determined by skin-to-stone distance on computed tomography. Urology 2005;66:941-944.
11.
Tiselius HG, Andersson A: Stone burden in an average Swedish population of stone formers requiring active stone removal: how can the stone size be estimated in the clinical routine? Eur Urol 2003;43:275-281.
12.
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;240:205-213.
13.
Amer T, Ahmed K, Bultitude M, Khan S, Kumar P, De Rosa A, Khan MS, Hegarty N: Standard versus tubeless percutaneous nephrolithotomy: a systematic review. Urol Int 2012;88:373-382.
14.
Yoshikawa K, Shimada M, Kurita N, Iwata T, Nishioka M, Morimoto S, Miyatani T, Komatsu M, Mikami C, Kashihara H: Visceral fat area is superior to body mass index as a predictive factor for risk with laparoscopy-assisted gastrectomy for gastric cancer. Surg Endosc 2011;25:3825-3830.
15.
Hagiwara M, Miyajima A, Hasegawa M, Jinzaki M, Kikuchi E, Nakagawa K, Oya M: Visceral obesity is a strong predictor of perioperative outcome in patients undergoing laparoscopic radical nephrectomy. BJU Int 2012;110(11 Pt C):E980-E984.
16.
Sergeyev I, Koi PT, Jacobs SL, Godelman A, Hoenig DM: Outcome of percutaneous surgery stratified according to body mass index and kidney stone size. Surg Laparosc Endosc Percutan Tech 2007;17:179-183.
17.
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;72:756-760.
18.
Pearle MS, Nakada SY, Womack JS, Kryger JV: Outcomes of contemporary percutaneous nephrostolithotomy in morbidly obese patients. J Urol 1998;160:669-673.
19.
Carson CC III, Danneberger JE, Weinerth JL: Percutaneous lithotripsy in morbid obesity. J Urol 1988;139:243-245.
20.
Curtis R, Thorpe AC, Marsh R: Modification of the technique of percutaneous nephrolithotomy in the morbidly obese patient. Br J Urol 1997;79:138-140.
21.
Giblin JG, Lossef S, Pahira JJ: A modification of standard percutaneous nephrolithotripsy technique for the morbidly obese patient. Urology 1995;46:491-493.
22.
Wang Y, Jiang F, Wang Y, Hou Y, Zhang H, Chen Q, Xu N, Lu Z, Hu J, Lu J, Wang X, Hao Y, Wang C: Post-percutaneous nephrolithotomy septic shock and severe hemorrhage: a study of risk factors. Urol Int 2012;88:307-310.
23.
Tefekli A, Karadag MA, Tepeler K, Sari E, Berberoglu Y, Baykal M, Sarilar O, Muslumanoglu AY: Classification of percutaneous nephrolithotomy complications using the modified Clavien grading system: looking for a standard. Eur Urol 2008;53:184-190.
24.
Toksoz S, Dirim A, Kizilkan Y, Ozkardes H: The effect of American Society of Anesthesiology scores on percutaneous nephrolithotomy outcomes. Urol Int 2012;89:301-306.
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