21 One-Shot Tract Dilatation for Supine Percutaneous Nephrolithotomy (PCNL) in Obese Patients

Abstract

Abstract Introduction With the rising incidence of both obesity and urolithiasis, the need to perform stone surgery in high BMI patients is increasing. We analysed the safety and efficacy of the one-shot tract dilatation (OSD) technique in obese patients undergoing supine percutaneous nephrolithotomy (PCNL). Method Retrospective review of all supine PCNLs performed by a single surgeon between January 2014 and December 2020. Patient factors (age and BMI), stone complexity and procedural characteristics (tract size and dilatation technique) were collected. Outcomes included access success, length of stay, operating duration, and inpatient complications. Results Overall 104 supine PCNLs were performed in 93 patients. Forty-four had a BMI >/ = 30 kg/m2 with a median age of 53 years, median BMI 35.12 kg/m2 and median Guy’s stone score of 2. When initial puncture was successful (43 cases (98%)), tract dilatation was satisfactory on all occasions. Dilatation was performed using a balloon dilator (24Ch) in 12 cases and OSD in 31 cases (range 16Ch to 24Ch, median 22Ch). Median length of stay was lower when OSD used (1 day) versus balloon (2 days), P = 0.03. Median operating time using OSD was 98 minutes versus 120 minutes using balloon (P = 0.10). There was no significant difference in operative time or length of stay when using OSD compared with BMI < 30 kg/m2. There were two Clavien-Dindo Grade I and one Grade II complications in patients where OSD was used. No transfusions were required. Conclusions One shot dilatation is an effective and safe means of access in obese patients when performing a supine PCNL.