Skip to main content
SpringerLink
Log in

Percutaneous Nephrolithotomy (PCNL) in Obese Patients: Overcoming the Difficulties

  • Chapter
  • First Online:
Difficult Cases in Endourology

  • 1013 Accesses

Abstract

The prevalence of obesity has significantly increased over recent decades in the United States and other developed western countries. With the rates of obesity and rates of nephrolithiasis rising in parallel, there is a suggestion that the two processes share a common pathophysiology. Obesity presents numerous challenges to the clinician. bese stone formers have been shown to have high stone recurrence rates after treatment compared to nonobese patients with nephrolithiasis. Surgical management of nephrolithiasis in obese individuals may be more laborious, may require additional procedures to achieve similar results, and may pose a higher risk of procedural morbidity to the patient. Herein, we present clinical scenarios of how an obese patient can complicate PCNL and suggest various techniques to overcome these challenges.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303(3):235–41.

    Article  PubMed  CAS  Google Scholar 

  2. Expert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Am J Clin Nutr. 1998;68(4):899–917.

    Google Scholar 

  3. Taylor EN, Stampfer MJ, Curhan GC. Obesity, weight gain, and the risk of kidney stones. JAMA. 2005;293(4):455–62.

    Article  PubMed  CAS  Google Scholar 

  4. Semins MJ, Shore AD, Makary MA, Magnuson T, Johns R, Matlaga BR. The association of increasing body mass index and kidney stone disease. J Urol. 2010;183(2):571–5.

    Article  PubMed  Google Scholar 

  5. Stamatelou KK, Francis ME, Jones CA, Nyberg LM, Curhan GC. Time trends in reported prevalence of kidney stones in the United States: 1976–1994. Kidney Int. 2003;63(5):1817–23.

    Article  PubMed  Google Scholar 

  6. Powell CR, Stoller ML, Schwartz BF, Kane C, Gentle DL, Bruce JE, Leslie SW. Impact of body weight on urinary electrolytes in urinary stone formers. Urology. 2000;55(6):825–30.

    Article  PubMed  CAS  Google Scholar 

  7. Li WM, Chou YH, Li CC, Liu CC, Huang SP, Wu WJ, Chen CW, Su CY, Lee MH, Wei YC, Huang CH. Association of body mass index and urine pH in patients with urolithiasis. Urol Res. 2009;37(4):193–6.

    Article  PubMed  Google Scholar 

  8. Taylor EN, Curhan GC. Body size and 24-hour urine composition. Am J Kidney Dis. 2006;48(6):905–15.

    Article  PubMed  CAS  Google Scholar 

  9. Ekeruo WO, Tan YH, Young MD, Dahm P, Maloney ME, Mathias BJ, Albala DM, Preminger GM. Metabolic risk factors and the impact of medical therapy on the management of nephrolithiasis in obese patients. J Urol. 2004;172(1):159–63.

    Article  PubMed  Google Scholar 

  10. Nishio S, Yokoyama M, Iwata H, Takeuchi M, Kamei O, Sugamoto T, Seike Y, Ochi K, Kin M, Aoki K, Nabeshima S, Takeda H, Takei S. Obesity as one of the risk factors for urolithiasis. Nippon Hinyokika Gakkai Zasshi. 1998;89(6):573–80.

    PubMed  CAS  Google Scholar 

  11. Fernström I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol. 1976;10(3):257–9.

    PubMed  Google Scholar 

  12. Skolarikos A, Alivizatos G, de la Rosette JJ. Percu­taneous nephrolithotomy and its legacy. Eur Urol. 2005;47(1):22–8.

    Article  PubMed  CAS  Google Scholar 

  13. Rais-Bahrami S, Friedlander JI, Duty BD, Okeke Z, Smith AD. Difficulties with access in percutaneous renal surgery. Ther Adv Urol. 2011;3(2):59–68.

    Article  PubMed  Google Scholar 

  14. Freedman DS, Khan LK, Serdula MK, et al. Trends and correlates of class 3 obesity in the United States from 1990 through 2000. JAMA. 2002;288:1758–61.

    Article  PubMed  Google Scholar 

  15. Carson 3rd CC, Danneberger JE, Weinerth JL. Percutaneous lithotripsy in morbid obesity. J Urol. 1988;139:243–5.

    PubMed  Google Scholar 

  16. Pearle MS, Nakada SY, Womack JS, et al. Outcomes of contemporary percutaneous nephrostolithotomy in morbidly obese patients. J Urol. 1998;160(pt 1):669–763.

    PubMed  CAS  Google Scholar 

  17. Koo BC, Burtt G, Burgess NA. Percutaneous stone surgery in the obese: outcome stratified according to body mass index. BJU Int. 2004;93:1296–9.

    Article  PubMed  CAS  Google Scholar 

  18. Gofrit ON, Shapiro A, Donchin Y, Bloom AI, Shenfeld OZ, Landau EH, Pode D. Lateral decubitus position for percutaneous nephrolithotripsy in the morbidly obese or kyphotic patient. J Endourol. 2002;16(6):383–6.

    Article  PubMed  Google Scholar 

  19. Hofmann R, Stoller ML. Endoscopic and open stone surgery in morbidly obese patients. J Urol. 1992;148(pt 2):1108–11.

    PubMed  CAS  Google Scholar 

  20. Manohar T, Jain P, Desai M. Supine percutaneous nephrolithotomy: effective approach to high-risk and morbidly obese patients. J Endourol. 2007;21(1):44–9.

    Article  PubMed  CAS  Google Scholar 

  21. Kerbl K, Clayman RV, Chandhoke PS, Urban DA, De Leo BC, Carbone JM. Percutaneous stone removal with the patient in a flank position. J Urol. 1994;151(3):686–8.

    PubMed  CAS  Google Scholar 

  22. Valdivia Uría JG, Lachares Santamaría E, Villarroya Rodríguez S, Taberner Llop J, Abril Baquero G, Aranda Lassa JM. Nefrolitectomía percutánea: Técnica simplificada (nota previa). Arch Esp Urol. 1987;40(3).

    Google Scholar 

  23. Desai MR, Jasani A. Percutaneous nephrolithotripsy in ectopic kidneys. J Endourol. 2000;14(3):289–92.

    Article  PubMed  CAS  Google Scholar 

  24. Francesca F, Felipetto R, Mosca F, Boggi U, Rizzo G, Puccini R. Percutaneous nephrolithotomy of transplanted kidney. J Endourol. 2002;16(4):225–7.

    Article  PubMed  Google Scholar 

  25. de la Rosette JJ, Tsakiris P, Ferrandino MN, Elsakka AM, Rioja J, Preminger GM. Beyond prone position in percutaneous nephrolithotomy: a comprehensive review. Eur Urol. 2008;54(6):1262–9.

    Article  PubMed  Google Scholar 

  26. Liu L, Zheng S, Xu Y, Wei Q. Systematic review and meta-analysis of percutaneous nephrolithotomy for patients in the supine versus prone position. J Endourol. 2010;24(12):1941–6.

    Article  PubMed  Google Scholar 

  27. Swerdlow BN, Brodsky JB, Butcher MD. Placement of a morbidly obese patient in the prone position. Anesthesiology. 1988;68(4):657–8.

    Article  PubMed  CAS  Google Scholar 

  28. Wu SD, Yilmaz M, Tamul PC, Meeks JJ, Nadler RB. Awake endotracheal intubation and prone patient self-positioning: anesthetic and positioning considerations during percutaneous nephrolithotomy in obese patients. J Endourol. 2009;23(10):1599–602.

    Article  PubMed  Google Scholar 

  29. Curtis R, Thorpe AC, Marsh R. Modification of the technique of percutaneous nephrolithotomy in the morbidly obese patient. Br J Urol. 1997;79(1):138–40.

    Article  PubMed  CAS  Google Scholar 

  30. Giblin JG, Lossef S, Pahira JJ. A modification of standard percutaneous nephrolithotripsy technique for the morbidly obese patient. Urology. 1995;46(4):491–3.

    Article  PubMed  CAS  Google Scholar 

  31. Nguyen TA, Belis JA. Endoscopic management of urolithiasis in the morbidly obese patient. J Endourol. 1998;12:33–5.

    Article  PubMed  CAS  Google Scholar 

  32. Bugeja S, Zammit P, German K. Use of a modified syringe barrel to ensure control of the amplatz sheath during percutaneous nephrolithotomy in obese patients. J Endourol. 2009;23:1817–9.

    Article  PubMed  Google Scholar 

  33. Castillo OA, Metrebian E, Vitagliano G. Laparoscopic retrieval of a migrated Amplatz sheath. JSLS. 2007;11(1):116–8.

    PubMed  Google Scholar 

  34. Srinivasan AK, Herati A, Okeke Z, Smith AD. Renal drainage after percutaneous nephrolithotomy. J Endourol. 2009;23(10):1743–9.

    Article  PubMed  Google Scholar 

  35. Yang RM, Bellman GC. Tubeless percutaneous renal surgery in obese patients. Urology. 2004;63(6):1036–40.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Arthur Smith Institute for Urology, Hofstra North Shore - Long Island Jewish School of Medicine, 450 Lakeville Road, New Hyde Park, NY, 11042, USA

    Soroush Rais-Bahrami M.D. & Arthur D. Smith M.D.

Authors
  1. Soroush Rais-Bahrami M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arthur D. Smith M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Soroush Rais-Bahrami M.D. .

Editor information

Editors and Affiliations

  1. Fac. Medicine, Dept. Surgery, Kuwait University, Safat, Kuwait

    Ahmed M. Al-Kandari

  2. , Department of Urology, Muljibhai Patel Urological Hospital, Dr Virendra Desai Road, Nadiad, 387 001, India

    Mahesh Desai

  3. , Urology and Nephrology Center, Mansoura University, Gomhoria Street, Mansoura, 35516, Egypt

    Ahmed A. Shokeir

  4. , Urology and Nephrology Center, Mansoura University, Gomhoria Street, Mansoura, 35516, Egypt

    Ahmed M. Shoma

  5. , Smith Institute for Urology, Long Island Jewish Health System, New York, 11040, USA

    Arthur D. Smith

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag London

About this chapter

Cite this chapter

Rais-Bahrami, S., Smith, A.D. (2013). Percutaneous Nephrolithotomy (PCNL) in Obese Patients: Overcoming the Difficulties. In: Al-Kandari, A., Desai, M., Shokeir, A., Shoma, A., Smith, A. (eds) Difficult Cases in Endourology. Springer, London. https://doi.org/10.1007/978-1-84882-083-8_16

Download citation

  • DOI: https://doi.org/10.1007/978-1-84882-083-8_16

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84882-082-1

  • Online ISBN: 978-1-84882-083-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation