Percutaneous nephrolithotomy for complex caliceal and staghorn stones in patients with solitary kidney

Abstract

Treatment of patients with solitary kidney having complex stones is one of the most challenging problem in urology. We present our experience with percutaneous nephrolithotomy (PCNL) in treating 16 patients with staghorn stones in a solitary kidney to determine long-term renal functional results. We retrospectively reviewed the records of 16 patients with complex caliceal or staghorn stones in a solitary kidney treated with PCNL. Demographic data, number and location of accesses, hemoglobin values, stone analyses, and complications were studied. Serum creatinine, glomerular filtration rate (GFR), systolic and diastolic blood pressure, new onset hypertension, and kidney morphology were determined preoperatively and postoperatively at 1 month and 1 year. Male to female ratio was 14:2 and mean age was 49.6 years (range 31-55). Of these, 10 (62.5%) patients required a single tract, while 6 (37.5%) required multiple tracts. The calculi were extracted or fragmented successfully in 13 (81.3%) patients and complete stone clearance was achieved after the first stage. In two patients with residual calculi, a double-J catheter was inserted and extracorporeal shock wave lithotripsy (SWL) was performed. There were no significant intraoperative problems except in one patient, who had bleeding from an infundibular tear attributable to torquing. During the 1-year study period, none of the patients progressed to end-stage renal disease requiring dialysis. We demonstrated a significant improvement in creatinine and GFR levels from preoperatively to 1-year follow-up. The number of patients with hypertension before PCNL was 5 and by the end of follow-up there was no new onset hypertension. The demonstrated effectiveness, small number of complications at short-term, not any poorly effect on renal function and blood pressure at the long-term follow-up confirm that PCNL is not only effective but is also safe in the solitary kidney with staghorn calculi.

Percutaneous-Based Management of Staghorn Calculi in Solitary Kidney: Combined Mini Percutaneous Nephrolithotomy versus Retrograde Intrarenal Surgery

“…We established 18-Fr mini tracts with the aim to decrease tract-related hemorrhage when multiple tracts were needed. The hemoglobin drop after PCNL was 3.5 ± 0.6 g/dl, and the transfusion rate was 13% in the PCNL monotherapy group in the present study, which was consist with other series, where the hemoglobin drop after PCNL ranged from 0.8 to 5.2 g/dl and the transfusion rate was 18.75% [10]. …”

Percutaneous Nephrolithotomy for Staghorn Stones in Patients with Solitary Kidney in Prone Position or in completely Supine Position: a Single-center Experience

“…Berkan et al (14) observed staghorn stones in 16 patients. The number of patients with hypertension before PCNL was fi ve and by the end of follow-up there was no new onset hypertension.…”

Tissue effects of intracorporeal lithotripsy techniques during percutaneous nephrolithotomy: comparison of pneumatic and ultrasonic lithotripters on rat bladder

“…Today, it is the treatment of choice for large-volume stone disease with the advantages of better stone clearance, costeVectiveness, and early convalescence as compared with other modalities like SWL or open surgery. An untreated kidney stone can damage the kidney; especially, struvite stones can destroy the kidney and cause life-threatening sepsis [4]. Studies have repeatedly demonstrated the safety and eYcacy of this minimally invasive technique, maintaining acceptable stone-free and symptom-free results, while minimizing associated complications [4][5][6][7].…”