Introduction: Mini-PCNL has gained popularity over the last decade due to its stone free rate comparable to traditional PCNL but with decreased risk of complications. Mini-PCNL has also furthered the movement of PCNL into the ambulatory setting. While the data on mini-PCNL has been favorable thus far, no study to date has evaluated outcomes in obese patients.
Methods: All patients undergoing mini-PCNL at our institution since we began its use in 2019 were included in this study. Mini-PCNL was defined as access sheath = 22 French in size. An obese group with BMI = 30 was compared to a non-obese group with BMI <30. A patient was considered stone free if there were no fragments >3 mm on follow-up CT. Fisher exact test was used to compare dichotomous differences between variables, and T-test to compare continuous variables.
Results: We identified 67 patients who underwent mini-PCNL during the study period with 33 patients in the obese group. Median BMI in the obese group was 36.4 kg/m2 compared to 25.05 kg/m2 in non-obese. There were no blood transfusions in either group during the study period. There was no statistical difference between the obese vs non-obese group for age, access sheath size, change in hemoglobin, same day discharge, percent stone free, Emergency Department visit within 30 days, and median largest single stone diameter (see table 1). There was a significant difference in the sum of all treated stone diameter in the obese group (median 15mm) versus non-obese (median 18mm, p=0.02) (table 1). There were no significant differences in overall complications or complication type. The two grade III complications included a pleural effusion requiring IR drainage, and an obstructing stone fragment that required ureteral stent placement.
Conclusions: Mini-PCNL appears to be equally safe and effective in obese and non-obese patients alike. While there was a statistically significantly higher amount of overall stone burden in the non-obese groups, the overall difference is not clinically significant. Further research is needed to validate our experience.
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