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Sekula NM, Basar M, Pal L. Impact of body weight on IVF: pathophysiology, outcomes, and clinical considerations. Curr Opin Obstet Gynecol 2025; 37:130-140. [PMID: 40172001 DOI: 10.1097/gco.0000000000001023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2025]
Abstract
PURPOSE OF REVIEW This study aimed to examine if excess body weight impacts the outcomes of IVF treatment cycles. RECENT FINDINGS While data on the effect and/or association of excess weight on IVF outcomes continue to produce mixed results, recent studies stratifying analyses by age are yielding clarity on a detrimental potential of obesity on IVF outcomes. Specifically, IVF outcomes in the third decade of life are susceptible to adverse implications of excess weight, as reflected in lower clinical pregnancy and live birth rates. Plausible pathogenic mechanisms underlying the detrimental impact of excess weight on IVF outcomes include inflammation, DNA repair, insulin resistance, and the targets of such mechanisms that include the spectrum of players critical to reproductive success, including the oocyte, sperm, embryo, and uterine receptivity. SUMMARY The detrimental implications of excess weight on IVF outcomes are more pronounced by age, and inflammatory processes seem to be particularly relevant to the interplay of weight excess, adiposity, and IVF cycle outcomes.
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Affiliation(s)
- Nicole M Sekula
- Department of Obstetrics, Gynecology and Reproductive Sciences
| | - Murat Basar
- Department of Obstetrics, Gynecology and Reproductive Sciences
- Division of Reproductive Endocrinology & Infertility, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lubna Pal
- Department of Obstetrics, Gynecology and Reproductive Sciences
- Division of Reproductive Endocrinology & Infertility, Yale School of Medicine, New Haven, Connecticut, USA
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Meshram T, Dang D, Sharma A, Kumari K, Rathod D, Bhatia P. Effects of intraoperative recruitment maneuver in patients with obesity undergoing laparoscopic surgery: A narrative review. J Anaesthesiol Clin Pharmacol 2025; 41:26-35. [PMID: 40026730 PMCID: PMC11867353 DOI: 10.4103/joacp.joacp_397_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 03/05/2025] Open
Abstract
In this article, we explored 18 studies showing the impact of the intraoperative recruitment maneuver on patients with obesity undergoing laparoscopic surgery. A recruiting maneuver accompanied by a more significant positive end-expiratory pressure enhances intraoperative oxygenation and respiratory mechanics in obese patients undergoing surgery. They are safe and do not have unfavorable hemodynamic consequences.
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Affiliation(s)
- Tanvi Meshram
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Deepanshu Dang
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ankur Sharma
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kamlesh Kumari
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Darshana Rathod
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pradeep Bhatia
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Petkar S, Chakole V, Nayak A. Comprehensive Review of Anesthetic Evaluation and Management in Obese Female Patients Undergoing In Vitro Fertilization. Cureus 2023; 15:e47521. [PMID: 38021482 PMCID: PMC10664690 DOI: 10.7759/cureus.47521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Obesity has become a global health epidemic with profound implications for various medical specialties, including reproductive medicine. This comprehensive review focuses on the anesthetic evaluation and management of obese patients undergoing in vitro fertilization (IVF) procedures. Obesity, as defined by BMI, is associated with infertility and poses unique challenges for anesthetic care. The review also addresses the timing of anesthesia concerning IVF procedures, the impact of obesity on IVF success rates, and the importance of emotional and psychological support for obese patients undergoing IVF. Challenges and future directions in the field are highlighted, focusing on ongoing research, emerging technologies, and the role of multidisciplinary teams in managing these complex cases. In conclusion, this review underscores the critical role of tailored anesthesia and perioperative care in optimizing outcomes for obese patients undergoing IVF. It provides valuable insights for anesthetic providers, reproductive specialists, and healthcare teams, emphasizing the need for a patient-centered approach to address the unique challenges posed by obesity in the context of assisted reproductive technology.
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Affiliation(s)
- Shubham Petkar
- Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vivek Chakole
- Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aishwarya Nayak
- Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Nie JW, Hartman TJ, Zheng E, Oyetayo OO, MacGregor KR, Federico VP, Massel DH, Sayari AJ, Singh K. Impact of body mass index on PROMIS outcomes following lumbar decompression. Acta Neurochir (Wien) 2023; 165:1427-1434. [PMID: 36892729 DOI: 10.1007/s00701-023-05534-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/11/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND No studies have examined the impact of body mass index (BMI) on newer Patient-Reported Outcomes Measurement Information System (PROMIS) outcomes in patients undergoing lumbar decompression (LD). METHODS Patients undergoing LD with preoperative PROMIS measures were stratified into four cohorts: normal (18.5 ≤ BMI < 25 kg/m2), overweight (25 ≤ BMI < 30 kg/m2), obese I (30 ≤ BMI < 35 kg/m2), and obese II-III (BMI ≥ 35 kg/m2). Demographics, perioperative characteristics, and patient-reported outcomes (PROs) were obtained. PROs of PROMIS Physical Function (PROMIS-PF), PROMIS Anxiety (PROMIS-A), PROMIS Pain Interference (PROMIS-PI), PROMIS Sleep Disturbance (PROMIS-SD), Patient Health Questionnaire-9 (PHQ-9), Visual Analog Scale (VAS) Back Pain (VAS-BP), VAS Leg Pain (VAS-LP), and Oswestry Disability Index (ODI) were collected at preoperative and up to 2-year postoperative time points. Minimum clinically important difference (MCID) achievement was determined through comparison of previously established values. Comparison between cohorts were determined through inferential statistics. RESULTS A total of 473 patients were identified, with stratification of 125 patients in the normal cohort, 161 in the overweight cohort, 101 in the obese I cohort, and 87 in the obese II-III cohort. Mean postoperative follow-up time was 13.51 ± 8.72 months. Higher BMI patients had higher operative times, longer postoperative length of stay, and greater narcotic consumption (p ≤ 0.001, all). Patients with higher BMI (obese I, obese II-III) reported inferior preoperative PROMIS-PF, VAS-BP, and ODI scores (p ≤ 0.003, all). Postoperatively, obese I-III cohorts demonstrated inferior PROMIS-PF, PHQ-9, VAS-BP, and ODI scores at final follow-up (p ≤ 0.016, all). However, patients demonstrated similar postoperative changes and MCID achievement regardless of preoperative BMI. CONCLUSION Patients undergoing lumbar decompression demonstrated similar postoperative improvement in physical function, anxiety, pain interference, sleep disturbance, mental health, pain, and disability outcomes independent of preoperative BMI. However, obese patients reported worse physical function, mental health, back pain, and disability outcomes at final postoperative follow-up. Patients with greater BMI undergoing lumbar decompression demonstrate inferior postoperative clinical outcomes.
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Affiliation(s)
- James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite #300, IL, 60612, Chicago, USA
| | - Timothy J Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite #300, IL, 60612, Chicago, USA
| | - Eileen Zheng
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite #300, IL, 60612, Chicago, USA
| | - Omolabake O Oyetayo
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite #300, IL, 60612, Chicago, USA
| | - Keith R MacGregor
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite #300, IL, 60612, Chicago, USA
| | - Vincent P Federico
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite #300, IL, 60612, Chicago, USA
| | - Dustin H Massel
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite #300, IL, 60612, Chicago, USA
| | - Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite #300, IL, 60612, Chicago, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite #300, IL, 60612, Chicago, USA.
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Goswami J, Lal J, Bhosale GP, Sinha A, Madhavi J. Exploring new frontiers: Organ transplant anaesthesia or bariatric anaesthesia. Indian J Anaesth 2021; 65:23-28. [PMID: 33767499 PMCID: PMC7980247 DOI: 10.4103/ija.ija_1449_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/17/2020] [Accepted: 12/30/2020] [Indexed: 11/21/2022] Open
Abstract
Unlike previous years, Anaesthesiology today is a major speciality encompassing many areas of modern medicine. Advent of various surgical sub-specialities resulted into the emergence of anaesthesia sub-specialities, as every group of surgery has specific need. Choosing the best-suited speciality is a complex matter. For that, one needs to have an idea about each one of them. A postgraduate anaesthesiology student does not have adequate exposure to choose the speciality. This article will give an overview of two important sub-specialities i.e., Organ Transplant Anaesthesia and Bariatric Anaesthesia.
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Affiliation(s)
- Jyotsna Goswami
- Department of Anaesthesia, Critical Care and Pain, Tata Medical Center, Kolkata, West Bengal, India
| | - Jatin Lal
- Department of Anaesthesiology and Critical Care, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, India
| | - Guruprasad P Bhosale
- Department of Anaesthesia and Critical Care, Institute of Kidney Diseases and Research Centre, Civil Hospital Campus, Ahmedabad, Gujarat, India
| | - Aparna Sinha
- Anesthesia Division, Max Institute of Laparoscopy Endoscopy and Bariatric Surgery, Max Hospital, Saket, New Delhi, India
| | - Julakanti Madhavi
- Upgraded Department of Anaesthesiology and Critical Care, Osmania Medical College, Hyderabad, Telangana, India
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Singh NP, Boyd CJ, Poore W, Wood K, Assimos DG. Obesity and Kidney Stone Procedures. Rev Urol 2020; 22:24-29. [PMID: 32523468 PMCID: PMC7265183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Obesity is a chronic disease that has increased in prevalence in the United States and is a risk factor for the development of nephrolithiasis. As with other medical conditions, obesity should be considered when optimizing surgical management and choosing kidney stone procedures for patients. In this review, we outline the various procedures available for treating stone disease and discuss any discrepancies in outcomes or complications for the obese cohort.
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Affiliation(s)
- Nikhi P Singh
- University of Alabama-Birmingham School of Medicine Birmingham, AL
| | - Carter J Boyd
- University of Alabama-Birmingham School of Medicine Birmingham, AL
| | - William Poore
- University of Alabama-Birmingham School of Medicine Birmingham, AL
| | - Kyle Wood
- Department of Urology, University of Alabama-Birmingham Birmingham, AL
| | - Dean G Assimos
- Department of Urology, University of Alabama-Birmingham Birmingham, AL
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Chang LC, Lee SC, Ding AL, Rajagopalan S. Fibreoptic Orotracheal Intubation of Obese Patients Using Parker Flex-Tip vs. Standard Endotracheal Tube. Turk J Anaesthesiol Reanim 2019; 47:387-391. [PMID: 31572989 DOI: 10.5152/tjar.2019.28909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 11/16/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Advancement of the endotracheal tube through a fibreoptic scope can sometimes prove to be challenging in obese patients. The Parker Flex-Tip endotracheal tube was developed with a curved and tapered distal tip to facilitate easier placement in the trachea. This study examined the use of the Parker Flex-Tip tube as compared to standard endotracheal tubes in patients with a body mass index of 30 or greater. Methods Sixty patients undergoing surgery requiring general anaesthesia were randomised into two groups. Using the fibreoptic scope, one group was intubated with the Parker Flex-Tip tube and the other group with a standard polyvinyl Portex tube. The time for intubation and the number of attempts required to place the endotracheal tube were measured and recorded. Results Using the Mann-Whitney U rank sum test, the median time needed for intubation with the two types of endotracheal tubes did not show a significant difference. The chi-square analyses were conducted for the number of attempts needed to place the endotracheal tubes, which also did not demonstrate any significant difference. Conclusions Parker Flex-Tip endotracheal tube was not superior to the standard endotracheal tubes for fibreoptic intubation in obese patients.
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Affiliation(s)
- Lee C Chang
- Department of Anaesthesiology, Baylor College of Medicine, Houston, Texas, USA
| | - Susan C Lee
- Department of Anaesthesiology, Baylor College of Medicine, Houston, Texas, USA
| | - Andrew L Ding
- Department of Anaesthesiology, Baylor College of Medicine, Houston, Texas, USA
| | - Suman Rajagopalan
- Department of Anaesthesiology, Baylor College of Medicine, Houston, Texas, USA
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Mengardo V, Pucetti F, Mc Cormack O, Chaudry A, Allum WH. The impact of obesity on esophagectomy: a meta-analysis. Dis Esophagus 2018; 31:4774514. [PMID: 29293968 DOI: 10.1093/dote/dox149] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Indexed: 12/11/2022]
Abstract
The impact of body mass index (BMI) on postoperative outcomes after curative resection for esophageal cancer has been assessed in many studies worldwide with conflicting conclusions. The aim of this meta-analysis is to evaluate the influence of preoperative BMI on surgical and oncologic outcomes after radical surgery for esophageal cancer, in Western studies. A comprehensive electronic search was performed to identify Western publications reporting BMI and outcomes following surgery for esophageal cancer. Articles that did not report preoperative BMI, postoperative morbidity, and early mortality were excluded. Statistical analysis was performed using the OpenMetaAnalyst software (Version 10.10). One hundred and ninety records were examined and 8 studies were included with a total of 2838 patients. The study population was stratified into two groups: a nonobese group (BMI < 30 kg/m2), containing 2199 patients, and an obese group (BMI ≥ 30 kg/m2), with 639 patients. In the obese group, there was an increased risk (up to 35%) of anastomotic leak (P = 0.003; RR: 0.857, 95% CI: 0.497, 0.867). The obese group showed a significantly more favorable five-year overall survival (P = 0.011). Although there was a significant association between anastomotic leak and obesity, patients with obesity also have a better overall 5-year survival. This meta-analysis demonstrates that patients with obesity should be counseled regarding the specific risks of surgery but they can be reassured that despite these risks overall outcome is satisfactory.
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Affiliation(s)
- V Mengardo
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
| | - F Pucetti
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
| | - O Mc Cormack
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
| | - A Chaudry
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
| | - W H Allum
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
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Anandhakrishnan A, Korbonits M. Glucagon-like peptide 1 in the pathophysiology and pharmacotherapy of clinical obesity. World J Diabetes 2016; 7:572-598. [PMID: 28031776 PMCID: PMC5155232 DOI: 10.4239/wjd.v7.i20.572] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/26/2016] [Accepted: 10/18/2016] [Indexed: 02/05/2023] Open
Abstract
Though the pathophysiology of clinical obesity is undoubtedly multifaceted, several lines of clinical evidence implicate an important functional role for glucagon-like peptide 1 (GLP-1) signalling. Clinical studies assessing GLP-1 responses in normal weight and obese subjects suggest that weight gain may induce functional deficits in GLP-1 signalling that facilitates maintenance of the obesity phenotype. In addition, genetic studies implicate a possible role for altered GLP-1 signalling as a risk factor towards the development of obesity. As reductions in functional GLP-1 signalling seem to play a role in clinical obesity, the pharmacological replenishment seems a promising target for the medical management of obesity in clinical practice. GLP-1 analogue liraglutide at a high dose (3 mg/d) has shown promising results in achieving and maintaining greater weight loss in obese individuals compared to placebo control, and currently licensed anti-obesity medications. Generally well tolerated, provided that longer-term data in clinical practice supports the currently available evidence of superior short- and long-term weight loss efficacy, GLP-1 analogues provide promise towards achieving the successful, sustainable medical management of obesity that remains as yet, an unmet clinical need.
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Pouwels S, Smeenk FW, Manschot L, Lascaris B, Nienhuijs S, Bouwman RA, Buise MP. Perioperative respiratory care in obese patients undergoing bariatric surgery: Implications for clinical practice. Respir Med 2016; 117:73-80. [PMID: 27492516 DOI: 10.1016/j.rmed.2016.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 04/19/2016] [Accepted: 06/06/2016] [Indexed: 12/16/2022]
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Neilly DW, Baliga S, Bidwell J, Kumar K. Closed reduction of anterior shoulder dislocation in the super obese. Am J Emerg Med 2015; 34:1181.e1-2. [PMID: 26616208 DOI: 10.1016/j.ajem.2015.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- David W Neilly
- Dept. of Trauma & Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, Scotland, UK.
| | - Santosh Baliga
- Dept. of Trauma & Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, Scotland, UK
| | - James Bidwell
- Dept. of Trauma & Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, Scotland, UK
| | - Kapil Kumar
- Dept. of Trauma & Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, Scotland, UK
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Al-Kalbani M, Burney IA. The Epidemics of Obesity and Cancer: No simple remedy. Sultan Qaboos Univ Med J 2014; 14:e294-6. [PMID: 25097762 PMCID: PMC4117652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 06/03/2023] Open
Affiliation(s)
- Moza Al-Kalbani
- Department of Obstetrics & Gynaecology, Sultan Qaboos University Hospital
| | - Ikram A. Burney
- Department of Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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Kuntz NJ, Neisius A, Astroza GM, Tsivian M, Iqbal MW, Youssef R, Ferrandino MN, Preminger GM, Lipkin ME. Does body mass index impact the outcomes of tubeless percutaneous nephrolithotomy? BJU Int 2014; 114:404-11. [DOI: 10.1111/bju.12538] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Nicholas J. Kuntz
- Comprehensive Kidney Stone Center; Division of Urologic Surgery; Duke University Medical Center; Durham NC USA
| | - Andreas Neisius
- Comprehensive Kidney Stone Center; Division of Urologic Surgery; Duke University Medical Center; Durham NC USA
- Department of Urology; University Medical Center Mainz; Mainz Germany
| | | | - Matvey Tsivian
- Comprehensive Kidney Stone Center; Division of Urologic Surgery; Duke University Medical Center; Durham NC USA
| | - Muhammad W. Iqbal
- Comprehensive Kidney Stone Center; Division of Urologic Surgery; Duke University Medical Center; Durham NC USA
| | - Ramy Youssef
- Comprehensive Kidney Stone Center; Division of Urologic Surgery; Duke University Medical Center; Durham NC USA
| | - Michael N. Ferrandino
- Comprehensive Kidney Stone Center; Division of Urologic Surgery; Duke University Medical Center; Durham NC USA
| | - Glenn M. Preminger
- Comprehensive Kidney Stone Center; Division of Urologic Surgery; Duke University Medical Center; Durham NC USA
| | - Michael E. Lipkin
- Comprehensive Kidney Stone Center; Division of Urologic Surgery; Duke University Medical Center; Durham NC USA
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