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Aktuelle Urol
DOI: 10.1055/a-2382-8423
Original Article

Comparison of supine and prone mini percutaneous nephrolithotomy in obese patients: a retrospective study

Vergleich der Mini-perkutanen Nephrolithotomie in Rücken- und Bauchlage bei adipösen Patienten: Eine retrospektive Studie
Mucahit Gelmis
1   Urology, Haseki Training and Research Hospital, Istanbul, Turkey (Ringgold ID: RIN147013)
,
Ufuk Caglar
1   Urology, Haseki Training and Research Hospital, Istanbul, Turkey (Ringgold ID: RIN147013)
,
Abdullah Esmeray
1   Urology, Haseki Training and Research Hospital, Istanbul, Turkey (Ringgold ID: RIN147013)
,
Nazım Furkan Gunay 
1   Urology, Haseki Training and Research Hospital, Istanbul, Turkey (Ringgold ID: RIN147013)
,
Caglar Dizdaroglu
1   Urology, Haseki Training and Research Hospital, Istanbul, Turkey (Ringgold ID: RIN147013)
,
Arda Meric 
1   Urology, Haseki Training and Research Hospital, Istanbul, Turkey (Ringgold ID: RIN147013)
,
Ali Ayranci
1   Urology, Haseki Training and Research Hospital, Istanbul, Turkey (Ringgold ID: RIN147013)
,
Faruk Ozgor
1   Urology, Haseki Training and Research Hospital, Istanbul, Turkey (Ringgold ID: RIN147013)
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Abstract

Introduction To compare the safety and effectiveness of Mini Percutaneous Nephrolithotomy (m-PNL) operations performed in the supine and prone positions in obese patients.

Methods We retrospectively analysed data from obese patients (BMI ≥ 30) who underwent prone or supine mPCNL between January 2014 and June 2021 in our clinic. Kidney anomalies, coagulopathy, solitary kidney, skeletal deformity, and patients under 18 were excluded. Outcomes measures included operation time, fluoroscopy time, duration of hospitalisation, stone-free rate, and complications classified by Clavien-Dindo. Statistical analysis was performed using SPSS version 26.

Results The study included 338 patients (100 supine, 238 prone). Supine mPCNL had a shorter mean operation time (89.6 vs. 100.3 minutes, p=0.001), fluoroscopy time, and duration of hospitalisation (60.7 vs. 112.0 hours, p=0.001). Overall complication rates were comparable, but major complications were higher in the prone group (p=0.041). Logistic regression identified stone size >25 mm and prone position as significant risk factors for major complications.

Conclusion Supine and prone mPCNL are both effective for treating kidney stones in obese patients. Supine mPCNL offers benefits, such as shorter operation time, reduced radiation exposure, and fewer major complications. Careful monitoring is recommended for patients with high CCI scores or larger stones due to increased complication risks.

Zusammenfassung

Einleitung Um die Sicherheit und Wirksamkeit von Mini-Perkutanen Nephrolithotomie-Operationen (m-PNL) zu vergleichen, die in Rücken- und Bauchlage bei adipösen Patienten durchgeführt wurden.

Methoden Wir haben retrospektiv Daten von adipösen Patienten (BMI ≥ 30) analysiert, die zwischen Januar 2014 und Juni 2021 in unserer Klinik einer mPCNL in Bauch- oder Rückenlage unterzogen wurden. Nierenanomalien, Koagulopathie, Einzelniere, Skelettdeformität und Patienten unter 18 Jahren wurden ausgeschlossen. Zu den gemessenen Ergebnissen gehörten Operationszeit, Durchleuchtungszeit, Krankenhausaufenthaltsdauer, Steinfreiheitsrate und Komplikationen, klassifiziert nach Clavien-Dindo. Die statistische Analyse wurde mit SPSS Version 26 durchgeführt.

Ergebnisse Die Studie umfasste 338 Patienten (100 in Rückenlage, 238 in Bauchlage). Bei mPCNL in Rückenlage war die durchschnittliche Operationszeit (89,6 vs. 100,3 Minuten, p=0,001), die Durchleuchtungszeit und die Dauer des Krankenhausaufenthalts (60,7 vs. 112,0 Stunden, p=0,001) kürzer. Die Gesamtkomplikationsraten waren vergleichbar, aber schwere Komplikationen traten in der Bauchlage häufiger auf (p=0,041). Die logistische Regression identifizierte Steingrößen >25 mm und Bauchlage als signifikante Risikofaktoren für schwere Komplikationen.

Schlussfolgerung mPCNL in Rückenlage und Bauchlage sind beide wirksam bei der Behandlung von Nierensteinen bei übergewichtigen Patienten. mPCNL in Rückenlage bietet Vorteile wie kürzere Operationszeit, geringere Strahlenbelastung und weniger schwere Komplikationen. Bei Patienten mit hohen CCI-Werten oder größeren Steinen wird aufgrund des erhöhten Komplikationsrisikos eine sorgfältige Überwachung empfohlen.

Keywords

Mini PNL - Obesity - Percutaneous Nephrolithotomy - Prone Position - Supine Position

Schlüsselwörter

Mini PNL - Fettleibigkeit - perkutane Nephrolithotomie - Bauchlage - Rückenlage


Publication History

Received: 23 April 2024

Accepted after revision: 07 August 2024

Article published online:
12 September 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 de Simone G, Devereux RB, Chinali M. et al. Strong Heart Study Investigators. Prognostic impact of metabolic syndrome by different definitions in a population with high prevalence of obesity and diabetes: the Strong Heart Study.. Diabetes Care 2007; 30: 1851-1856
    CrossrefPubMedSearch in Google Scholar
  • 2 Chooi YC, Ding C, Magkos F. The epidemiology of obesity. Metabolism 2019; 92: 6-10
    CrossrefPubMedSearch in Google Scholar
  • 3 Türk C, Petřík A, Sarica K. et al. EAU Guidelines on Interventional Treatment for Urolithiasis.. Eur Urol 2016; 69: 475-482
    CrossrefPubMedSearch in Google Scholar
  • 4 Valdivia Uría JG, Lachares Santamaría E, Villarroya Rodríguez S. et al. Nefrolitectomía percutánea: técnica simplificada (nota previa) [Percutaneous nephrolithectomy: simplified technic (preliminary report)]. Arch Esp Urol 1987; 40: 177-180
    PubMedSearch in Google Scholar
  • 5 Giusti G, Pavia MP, Rico L. et al. Percutaneous Nephrolithotomy: Which Position?. Supine Position! Eur Urol Open Sci 2021; 35: 1-3
    CrossrefPubMedSearch in Google Scholar
  • 6 Chapagain A, Basnet RB, Shah C. et al. Comparative Study of Percutaneous Nephrolithotomy in Supine and Prone Positions. J Nepal Health Res Counc 2021; 19: 154-157
    CrossrefPubMedSearch in Google Scholar
  • 7 Wu P, Wang L, Wang K. Supine versus prone position in percutaneous nephrolithotomy for kidney calculi: a meta-analysis. Int Urol Nephrol 2011; 43: 67-77
    CrossrefPubMedSearch in Google Scholar
  • 8 Ding X, Hao Y, Jia Y. et al. 3-dimensional ultrasound-guided percutaneous nephrolithotomy: total free versus partial fluoroscopy. World J Urol 2020; 38: 2295-2300
    CrossrefPubMedSearch in Google Scholar
  • 9 Zampini AM, Bamberger JN, Gupta K. et al. Factors Affecting Patient Radiation Exposure During Prone and Supine Percutaneous Nephrolithotomy. J Endourol 2021; 35: 1448-1453
    CrossrefPubMedSearch in Google Scholar
  • 10 Wang M, Huang J, Chagpar AB. Do Obese Breast Cancer Patients Have More Complications and a Longer Length of Stay After Mastectomy Than Nonobese Patients?. Am Surg 2021; 87: 1099-1106
    CrossrefPubMedSearch in Google Scholar
  • 11 Huynh MJ, Wang Y, Chang SL. et al. The cost of obesity in radical cystectomy. Urol Oncol 2020; 38: 932.e9-932.e14
    CrossrefPubMedSearch in Google Scholar
  • 12 Trudeau V, Karakiewicz PI, Boehm K. et al. The Effect of Obesity on Perioperative Outcomes Following Percutaneous Nephrolithotomy. J Endourol 2016; 30: 864-70
    CrossrefPubMedSearch in Google Scholar
  • 13 Wu P, Wang L, Wang K. Supine versus prone position in percutaneous nephrolithotomy for kidney calculi: a meta-analysis. Int Urol Nephrol 2011; 43: 67-77
    CrossrefPubMedSearch in Google Scholar
  • 14 Jones MN, Ranasinghe W, Cetti R. et al. Modified supine versus prone percutaneous nephrolithotomy: Surgical outcomes from a tertiary teaching hospital. Investig Clin Urol 2016; 57: 268-273
    CrossrefPubMedSearch in Google Scholar
  • 15 Li J, Gao L, Li Q. et al. Supine versus prone position for percutaneous nephrolithotripsy: A meta-analysis of randomized controlled trials. Int J Surg 2019; 66: 62-71
    CrossrefPubMedSearch in Google Scholar
  • 16 Yuan D, Liu Y, Rao H. et al. Supine Versus Prone Position in Percutaneous Nephrolithotomy for Kidney Calculi: A Meta-Analysis. J Endourol 2016; 30: 754-763
    CrossrefPubMedSearch in Google Scholar
  • 17 Seitz C, Desai M, Häcker A. et al. Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy. Eur Urol 2012; 61: 146-158
    CrossrefPubMedSearch in Google Scholar
  • 18 Falahatkar S, Mokhtari G, Teimoori M. An Update on Supine Versus Prone Percutaneous Nephrolithotomy: A Meta-analysis. Urol J 2016; 13: 2814-2822
    PubMedSearch in Google Scholar
  • 19 Unsal A, Resorlu B, Atmaca AF. et al. Prediction of morbidity and mortality after percutaneous nephrolithotomy by using the Charlson Comorbidity Index. Urology 2012; 79: 55-60
    CrossrefPubMedSearch in Google Scholar
  • 20 Sahan M, Yarimoglu S, Sarilar O. et al. Supine versus Prone Miniaturised Percutaneous Nephrolithotomy in Elderly Patients. J Coll Physicians Surg Pak 2022; 32: 340-345
    CrossrefPubMedSearch in Google Scholar