Chung SD et al, 2014: Percutaneous nephrolithotomy increases the risk of diabetes: A 5-year follow-up study
Chung SD, Lin CC, Lin HC
Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, Banciao; Sleep Research Center, Taipei Medical University Hospital
OBJECTIVE: To examine the risk of diabetes mellitus within a 5-year period among patients with nephrolithiasis undergoing percutaneous nephrolithotomy.
METHODS: A total of 304 patients who underwent percutaneous nephrolithotomy were included in the study cohort. A total of 3040 patients with nephrolithiasis who did not undergo percutaneous nephrolithotomy were used as a comparison cohort. All participants included in the present study were individually tracked for a 5-year period in order to identify those who developed diabetes mellitus during this timeframe.
RESULTS: The incidence rate of diabetes mellitus was 3.03 per 100 person-years in participants who underwent percutaneous nephrolithotomy and 1.65 per 100 person-years in participants who did not undergo percutaneous nephrolithotomy. After adjusting for the participants' monthly income, geographic location, urbanization level, hypertension, hyperlipidemia and alcohol abuse/alcohol dependence syndrome, the hazard ratio of receiving a first diagnosis of diabetes mellitus during the 5-year follow-up period was 1.96 (95% confidence interval 1.40-2.77) for participants who underwent percutaneous nephrolithotomy. Furthermore, compared with extracorporeal shock wave lithotripsy or endoscopic intervention, participants who underwent percutaneous nephrolithotomy had a significantly increased hazard of developing diabetes mellitus (adjusted hazard ratio 1.79 for a percutaneous nephrolithotomy vs extracorporeal shockwave lithotripsy, and adjusted hazard ratio 1.71 for a percutaneous nephrolithotomy vs an endoscopic intervention).
CONCLUSIONS: The present results suggest an association between patients with nephrolithiasis who undergo a percutaneous nephrolithotomy and a subsequent diabetes mellitus diagnosis.
Int J Urol. 2014 Mar 4. doi: 10.1111/iju.12418. [Epub ahead of print]. PMID:24593242[PubMed - as supplied by publisher]. FREE ARTICLE
This report shows that the reason for development of DM in patients with urolithiasis seems unrelated to the method used for stone removal. It is likely, as the authors also suggest that the reason for a higher risk of developing DM in the PCNL-treated patients was that this group had a more severe stone disease. Although no patients in this report were treated with SWL it is an interesting observation in view of other reports that have claimed that there has been an association between SWL and DM.