Ronald M Yang1, Gary C Bellman. 1. Department of Urology, Kaiser-Permanente Medical Center, Los Angeles, California 90027, USA.
Abstract
OBJECTIVES: To assess the outcome and safety of tubeless percutaneous renal surgery in overweight and obese patients. METHODS: A single urologist performed tubeless percutaneous renal surgery on a total of 138 renal units in 133 patients from March 1996 to January 2003. The tubeless procedures consisted of either nephrolithotripsy or endopyelotomy. We analyzed the clinical data of a subset of these patients who were of considered normal weight (body mass index [BMI] 18.5 kg/m2 or greater but less than 25 kg/m2), overweight (BMI 25 kg/m2 or greater but less than 30 kg/m2), obese (BMI 30 kg/m2 or greater but less than 40 kg/m2), and morbidly obese (BMI 40 kg/m2 or greater). RESULTS: Of the 133 patients, 5 (3.8%) were considered morbidly obese, 28 (21.1%) were considered obese, 55 (41.4%) were considered overweight, and 45 (34%) were considered to be of normal weight. Of the 133 patients, 104 underwent percutaneous stone extraction and 29 underwent percutaneous antegrade endopyelotomy. Using unpaired t testing, BMI was compared with the transfusion rates, days of hospitalization, and stone-free outcome. The stone group did not demonstrate statistically significant relationships between BMI and transfusion rate, length of hospitalization, and stone-free outcome (P = 0.423, P = 0.105, and P = 0.127, respectively). A stone-free rate of 94.5% was achieved. In the endopyelotomy group, 29 patients were analyzed. Follow-up showed 24 patients (82.8%) had successful resolution of the ureteropelvic junction obstruction 1 year postoperatively. Two patients required readmission for gross hematuria and low hematocrit. One patient required selective angiographic embolization of a pseudoaneurysm. CONCLUSIONS: Tubeless percutaneous renal surgery is a safe and effective procedure in overweight, obese, and morbidly obese patients.
OBJECTIVES: To assess the outcome and safety of tubeless percutaneous renal surgery in overweight and obesepatients. METHODS: A single urologist performed tubeless percutaneous renal surgery on a total of 138 renal units in 133 patients from March 1996 to January 2003. The tubeless procedures consisted of either nephrolithotripsy or endopyelotomy. We analyzed the clinical data of a subset of these patients who were of considered normal weight (body mass index [BMI] 18.5 kg/m2 or greater but less than 25 kg/m2), overweight (BMI 25 kg/m2 or greater but less than 30 kg/m2), obese (BMI 30 kg/m2 or greater but less than 40 kg/m2), and morbidly obese (BMI 40 kg/m2 or greater). RESULTS: Of the 133 patients, 5 (3.8%) were considered morbidly obese, 28 (21.1%) were considered obese, 55 (41.4%) were considered overweight, and 45 (34%) were considered to be of normal weight. Of the 133 patients, 104 underwent percutaneous stone extraction and 29 underwent percutaneous antegrade endopyelotomy. Using unpaired t testing, BMI was compared with the transfusion rates, days of hospitalization, and stone-free outcome. The stone group did not demonstrate statistically significant relationships between BMI and transfusion rate, length of hospitalization, and stone-free outcome (P = 0.423, P = 0.105, and P = 0.127, respectively). A stone-free rate of 94.5% was achieved. In the endopyelotomy group, 29 patients were analyzed. Follow-up showed 24 patients (82.8%) had successful resolution of the ureteropelvic junction obstruction 1 year postoperatively. Two patients required readmission for gross hematuria and low hematocrit. One patient required selective angiographic embolization of a pseudoaneurysm. CONCLUSIONS: Tubeless percutaneous renal surgery is a safe and effective procedure in overweight, obese, and morbidly obesepatients.