Endourological management in single kidney: is percutaneous nephrolithotomy a safe procedure for complex stones?
DOI:
https://doi.org/10.48193/sz2g4v39Keywords:
Urolithiasis, Single kidney, PCNL (Percutaneous Nephrolithotomy), Complications, Stone-free rateAbstract
Introduction: Urolithiasis in a solitary kidney is a significant endourological challenge, any procedures to kidney or its drainage can lead to significant morbidity. There is no international consensus for its management. Procedure selection should be based on stone burden, comorbidities, and complications.
Objectives: To describe the clinical characteristics, complications, and stone-free rates of patients with solitary kidneys and complex renal stones from July 2017 to September 2023.
Materials and methods: A descriptive, retrospective study was conducted on patients with solitary kidneys and renal stones classified as GUY III and IV treated with PCNL. Continuous variables were expressed as means ± standard deviation. T-Student or U-Mann-Whitney tests, χ², Spearman or Pearson correlations, and ANOVA were utilized as appropriate. A P-value <0.05 was considered statistically significant.
Results: a total of 318 records were analyzed, of which 26 patients were included, with 84.6 % being female and a mean age of 45.15 years. All patients had a history of previous episodes of renal lithiasis. The mean stone burden was 984.92 mm3, with a STONE SCORE of 9.3. The stone-free rate was 30.8 % after a single procedure, with Clavien-Dindo I complications in 15.38 % of cases and renal function improvement in 57.7 %. Stone burden, Stone Score, and stone density were significantly associated with the stone-free rate.
Conclusion: PCNL emerges as one of the most effective and safest techniques with few complications for complex stones in solitary kidney patients, with minimal impact on renal function
References
Osther PJS. Risks of flexible ureterorenoscopy: pathophysiology and prevention. Urolithiasis. 2018;46(1): 59–67. https://doi.org/10.1007/s00240-017-1018-6.
Khan SR, Pearle MS, Robertson WG, Gambaro G, Canales BK, Doizi S, et al. Kidney stones. Nature Reviews. Disease Primers. 2016;2: 16008. https://doi.org/10.1038/nrdp.2016.8.
Sorokin I, Mamoulakis C, Miyazawa K, Rodgers A, Talati J, Lotan Y. Epidemiology of stone disease across the world. World Journal of Urology. 2017;35(9): 1301–1320. https://doi.org/10.1007/s00345-017-2008-6.
Fang Y, Liu Y, Huang H, Zhang G, Zou X, Xie T. Analysis of risk factors for SIRS after PCNL in patients with solitary kidney. Urolithiasis. 2024;53(1): 10. https://doi.org/10.1007/s00240-024-01681-1.
Gao X, Fang Z, Lu C, Shen R, Dong H, Sun Y. Management of staghorn stones in special situations. Asian Journal of Urology. 2020;7(2): 130–138. https://doi.org/10.1016/j.ajur.2019.12.014.
Karkin K, Erçil H. Is percutaneous nephrolithotomy effective and safe for children with solitary kidney? Pediatric Surgery International. 2022;38(8): 1171–1175. https://doi.org/10.1007/s00383-022-05147-6.
Bucuras V, Gopalakrishnam G, Wolf JS, Sun Y, Bianchi G, Erdogru T, et al. The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: nephrolithotomy in 189 patients with solitary kidneys. Journal of Endourology. 2012;26(4): 336–341. https://doi.org/10.1089/end.2011.0169.
Zhang Y, Wu Y, Li J, Zhang G. Comparison of Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery for the Treatment of Lower Calyceal Calculi of 2-3 cm in Patients With Solitary Kidney. Urology. 2018;115: 65–70. https://doi.org/10.1016/j.urology.2017.11.063.
Pietropaolo A, Reeves T, Aboumarzouk O, Kallidonis P, Ozsoy M, Skolarikos A, et al. Endourologic Management (PCNL, URS, SWL) of Stones in Solitary Kidney: A Systematic Review from European Association of Urologists Young Academic Urologists and Uro-Technology Groups. Journal of Endourology. 2020;34(1): 7–17. https://doi.org/10.1089/end.2019.0455.
Suárez-Ibarrola AHRR. Manejo de litiasis renal con nefrolitotomía percutánea: experiencia de un hospital de referencia. Revista Mexicana de Urología. 2014;74(4). https://doi.org/10.48193/revistamexicanadeurologa.v74i4.188.
Haberal HB, Çıtamak B, Bozacı AC, Yazıcı MS, Aki FT, Bilen CY. Percutaneous Nephrolithotomy in Solitary Kidneys: 17 Years of Experience. Urology. 2017;109: 55–59. https://doi.org/10.1016/j.urology.2017.07.038.
Medina-Escobedo M, Alcocer-Dzul R, López-López J, Villanueva-Jorge S. Obesidad como factor de riesgo para alteraciones metabólicas en adultos con litiasis urinaria. Revista Médica del Instituto Mexicano del Seguro Social. 2015;53(6): 692–697.
Basulto-Martínez M, Peña-Espinoza B, Valdez-Ortiz R, Escalante-Sosa R, Flores-Tapia JP, Menjivar M. High Prevalence of Hypocitraturia in Stone Formers from the Maya Region of Yucatan, Mexico. Archives of Medical Research. 2022;53(1): 69–78. https://doi.org/10.1016/j.arcmed.2021.05.006.
Abufaraj M, Xu T, Cao C, Waldhoer T, Seitz C, D’andrea D, et al. Prevalence and Trends in Kidney Stone Among Adults in the USA: Analyses of National Health and Nutrition Examination Survey 2007-2018 Data. European Urology Focus. 2021;7(6): 1468–1475. https://doi.org/10.1016/j.euf.2020.08.011.
Shi X, Peng Y, Li L, Li X, Wang Q, Zhang W, et al. Renal function changes after percutaneous nephrolithotomy in patients with renal calculi with a solitary kidney compared to bilateral kidneys. BJU international. 2018;122(4): 633–638. https://doi.org/10.1111/bju.14413.
El-Nahas AR, Shokeir AA, El-Assmy AM, Mohsen T, Shoma AM, Eraky I, et al. Post-percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors. The Journal of Urology. 2007;177(2): 576–579. https://doi.org/10.1016/j.juro.2006.09.048.
Liu C, Cui Z, Zeng G, Wan SP, Li J, Zhu W, et al. The optimal minimally invasive percutaneous nephrolithotomy strategy for the treatment of staghorn stones in a solitary kidney. Urolithiasis. 2016;44(2): 149–154. https://doi.org/10.1007/s00240-015-0803-3.
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