The feasibility of one-stage flexible ureteroscopy lithotripsy in solitary kidney patients with 1–3 cm renal stones and risk factors of renal function changes

Conservative treatment is closely associated with renal deterioration for patients with renal staghorn stones. It is well-recognized that percutaneous nephrolithotomy (PCNL) is recommended as the first-line treatment of renal stones larger than 2 cm due to its higher stone clearance and cost-effectiveness when compared with other treatment alternatives, such as shockwave lithotripsy and flexible ureteroscopy (FURS). Besides, our findings indicated that miniaturized PCNL could be served as an alternative to PCNL with a higher stone-free rate and a lower hemorrhage risk. Despite the higher cost-effectiveness of PCNL, the management of staghorn stones are still controversial in some special situations, such as a solitary kidney. Herein, we present a case with complex infectious stones of a right-sided solitary kidney, complaining of persistent pain in the right waist. The rarity of this case is that it is difficult to encounter these cotton-like staghorn stones which are clinically resistant to holmium laser lithotripsy, and the particularity is that the patient with solitary kidney failed to undergo PCNL. We found that the combination of intermittently high-frequency oscillation and flexible ureteroscopy forceps might contribute to treat the complex infectious stones in a patient with solitary kidney. Our surgical experience might be beneficial to such patients undergoing flexible ureteroscopy in clinical practice.

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Renal function evaluation after percutaneous nephrolithotomy in patients with solitary kidney

Iraq Medical Journal ◽

10.22317/imj.v5i2.1027 ◽

2021 ◽

Vol 5 (2) ◽

Keyword(s):

Renal Function ◽

Serum Creatinine ◽

Creatinine Clearance ◽

Percutaneous Nephrolithotomy ◽

Operation Time ◽

Renal Stones ◽

Solitary Kidney ◽

Early Postoperative Period ◽

Function Evaluation ◽

Time Duration

Objective: To evaluate renal function change after percutaneous nephrolithotomy in patients with solitary kidney. Methods: A prospective study conducted in the urology department at Rizgary Teaching Hospital for a period of 15 months from first of June 2018 until the end of August 2019. It included nine adult patients, all of them with solitary kidney and undergone percutaneous nephrolithotomy for management of renal calculi. Patients were considered to have a solitary kidney in case of congenital abnormality, contralateral nephrectomy, or solitary functioning kidney with contralateral atrophy (relative function < 10%). All patients were received prophylactic antibiotics (Ceftriaxone) at induction of anesthesia. All percutaneous nephrolithotomy procedures performed under general anesthesia in the prone position. Serum creatinine and creatinine clearance before the operation, at day one and day 21 postoperatively, operation time, duration of hospitalization, and postoperative complications recorded. Results: In this study, Means of serum creatinine at 1 day and 21 days postoperatively were significantly decreased compared to preoperative s. creatinine level Mean of creatinine clearance significantly increased after 21 days postoperatively compared to preoperative test, while no significant change in creatinine clearance after one day postoperatively. Conclusion: Generally, percutaneous nephrolithotomy considered as a safe and effective option for treatment of renal stones in solitary kidney patients considering the overall rate of complications and minimal morbidity. Moreover, significant renal function improvement anticipated in the early postoperative period.

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Risk factors for deterioration of renal function after percutaneous nephrolithotomy in solitary kidney patients with staghorn calculi

Translational Andrology and Urology ◽

10.21037/tau-20-916 ◽

2020 ◽

Vol 9 (5) ◽

pp. 2022-2030

Author(s):

Jiahao Wang ◽

Yunjin Bai ◽

Shan Yin ◽

Jianwei Cui ◽

Yin Tang ◽

...

Keyword(s):

Risk Factors ◽

Renal Function ◽

Percutaneous Nephrolithotomy ◽

Solitary Kidney ◽

Staghorn Calculi

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Risk factors of long-term postoperative renal function after partial nephrectomy in a solitary kidney

Open Life Sciences ◽

10.1515/biol-2017-0057 ◽

2017 ◽

Vol 12 (1) ◽

pp. 481-488

Author(s):

Jie Zhu ◽

Timur Kuru ◽

Yingqi Wei ◽

Gencay Hatiboglu ◽

Valentin Popeneciu ◽

...

Keyword(s):

Risk Factors ◽

Renal Function ◽

Partial Nephrectomy ◽

Solitary Kidney ◽

Warm Ischemia ◽

Warm Ischemia Time ◽

Ischemia Time ◽

Function Change ◽

Postoperative Renal Function

AbstractThe effect of warm ischemia time (WIT) on longterm renal function after partial nephrectomy remains controversial. In this retrospectively cohort study, 75 solitary kidney patients were included and the effects of warm ischemia time, preoperative renal function and resected normal parenchyma volume on long-term renal function were evaluated. Multivariable analysis showed that the preoperative renal function baseline was significantly associated with renal function 12 months postoperation (P=0.01), adjusting for age and comorbidities factors. Meanwhile, perioperative acute renal failure (ARF) events significantly affected postoperative renal function at postoperative time points of 12 months (P=0.001) and 60 months (P=0.03), as well as renal function change at postoperative 12 months (P<0.01). Warm ischemia time and resected normal parenchyma volume were not risk factors for long-term postoperative renal function, while the latter was significantly associated with renal function change (P=0.03 at 12 months, P<0.01 at 36 and 60 months).In conclusion, the quality of preoperative kidney primarily determines long-term postoperative renal function, while the quantity of preserved functional parenchyma volume was the main determinant for long-term kidney recovery. ARF was an independent risk factor while WIT was indirectly associated with postoperative renal function by causing perioperative ARF.

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