Long-term outcomes of ultrasound-guided percutaneous nephrolithotomy in patients with solitary kidneys: a single-center experience
- 108 Downloads
To report our experience with total ultrasound-guided percutaneous nephrolithotomy (PCNL) in the management of patients with solitary kidney, and evaluate the safety and feasibility of this technique.
Materials and methods
Between October 2014 and December 2016, 48 patients with solitary kidneys underwent total ultrasound-guided PCNL at our institution. Stone-free rate (SFR), auxiliary procedures, and complications were recorded. Changes in renal function were evaluated by comparing preoperative and postoperative estimated glomerular filtration rates (eGFRs). Perioperative factors that may affect renal function were analyzed to define factors predicting renal function improvement on long-term follow-up. Of 48 patients, 44 were followed at least 6 months, whereas four patients were lost to follow-up.
Among all patients, staghorn calculi were found in 18 (37.5%) patients. 14 (29.2%) patients required a two-stage PCNL. Struvite was found in six (12.5%) patients. Complications were reported in eight (16.7%) patients. Severe bleeding was noticed in three patients; no angioembolization was required. After a median follow-up of 12 (6–26) months, the final SFR was 81.8% after auxiliary treatments. There was a significant improvement of eGFR from 53.9 ± 24.0 to 61.3 ± 25.4 mL/min/1.73 m2 (P < 0.01). Renal function was stable, improved and worse in 65.9% (n = 29), 27.3% (n = 12), and 6.8% (n = 3) of patients, respectively, compared with preoperative levels.
Ultrasound-guided PCNL is a safe and feasible procedure with an acceptably low complication rate in patients with solitary kidneys. At long-term follow-up, the renal function in more than 90% of the patients with solitary kidneys can be improved or stabilized after ultrasound-guided PCNL.
KeywordsUltrasound guidance PCNL Solitary kidney
Estimated glomerular filtration rate
Chronic kidney disease
Clinically insignificant residual fragments
Retrograde intrarenal surgery
Type 2 diabetes mellitus
- 7.Li J, Xiao B, Hu W et al (2014) Complication and safety of ultrasound guided percutaneous nephrolithotomy in 8025 cases in China. Chin Med J (Engl) 127:4184Google Scholar
- 21.Tanaka Y, Hatakeyama S, Tanaka T et al (2017) The influence of serum uric acid on renal function in patients with calcium or uric acid stone: a population-based analysis. PLoS One 12:e182136Google Scholar
- 22.Liou LS, Streem SB (2001) Long-term renal functional effects of shock wave lithotripsy, percutaneous nephrolithotomy and combination therapy: a comparative study of patients with solitary kidney. J Urol 166(36):36Google Scholar