Mp04-11 Robotic-Assisted Laparoscopic Pyelolithotomy: Alternative Management for Large Renal Stones in an Obese, Appalachian Cohort

You have accessJournal of UrologyStone Disease: Surgical Therapy (including ESWL) I (MP04)1 May 2024MP04-11 ROBOTIC-ASSISTED LAPAROSCOPIC PYELOLITHOTOMY: ALTERNATIVE MANAGEMENT FOR LARGE RENAL STONES IN AN OBESE, APPALACHIAN COHORT David Zekan, Zachary Edgerton, Charles Gish, Daniel McClelland, Chad Morley, Michael Ost, Mohamad Salkini, and John Barnard David ZekanDavid Zekan , Zachary EdgertonZachary Edgerton , Charles GishCharles Gish , Daniel McClellandDaniel McClelland , Chad MorleyChad Morley , Michael OstMichael Ost , Mohamad SalkiniMohamad Salkini , and John BarnardJohn Barnard View All Author Informationhttps://doi.org/10.1097/01.JU.0001008708.00982.a9.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Treatment of renal calculus disease in obese patients presents unique challenges. Skin-to-stone distance and prone positioning can preclude percutaneous nephrolithotripsy (PCNL) in these patients. One underutilized alternative to ureteroscopic and percutaneous stone treatments is robotic-assisted laparoscopic pyelolithotomy (RALPL). Our group sought to examine the safety and efficacy of this approach in treating renal stones in a particularly obese, underserved cohort in Appalachia and compare their outcomes to patients who had RALPL for an alternative reason (concurrent UPJO, ureteral stricture, pelvic kidney). METHODS: We compiled all RALPL performed at our tertiary care institution from 1/2017-10/2023, which serves a majority of West Virginia. We identified obese patients and non-obese in this cohort and compared gender, BMI, laterality, stone burden, skin-to-stone distance, length of hospital stay, residual stone, complications within one month, blood loss, operative time, and follow up time. Obesity was defined as a body mass index (BMI) of>30.0 kg/m2. Stone-free rate was defined as lack of observable stone fragments noted at completion of procedure and lack of stone fragments noted on postoperative imaging. Appropriate statistical tests (chi2 and students t-tests) were performed using SPSS. RESULTS: In total, 13 non-obese and 17 obese patients underwent RALPL. There were no statistically significant differences in gender, laterality, stone burden, skin-to-stone distance, length of stay, residual stone, complications within one-month, operative time, or follow up time (Table 1). Obviously, there were significant differences in BMI, but also blood loss, in the obese and non-obese groups, with the non-obese group demonstrating less blood loss (27.7 vs. 74.4 mL, p=0.04). CONCLUSIONS: Herein, we indicate that RALPL is a reasonable option for management of large volume renal calculi in obese patients in a particularly at-risk cohort in rural Appalachia. Outcomes between obese patients and non-obese patients who have RALPL are similar, aside from blood loss, in which the difference does not reach clinical significance. Thus, RALPL may be offered to patients who cannot tolerate endoscopic stone surgery due to positioning, skin-to-stone distance, or both. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e38 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information David Zekan More articles by this author Zachary Edgerton More articles by this author Charles Gish More articles by this author Daniel McClelland More articles by this author Chad Morley More articles by this author Michael Ost More articles by this author Mohamad Salkini More articles by this author John Barnard More articles by this author Expand All Advertisement PDF downloadLoading ...