Retrograde intrarenal surgery for urinary stone disease in patients with solitary kidney: A retrospective analysis of the efficacy and safety

Abstract

Abbreviations & Acronyms Dcreatinine = change in serum creatinine level DGFR = amount of change in glomerular filtration rate CT = computed tomography eGFR = estimated glomerular filtration rate GFR = glomerular filtration rate KUB = kidney-ureterbladder PCNL = percutaneous nephrolithotomy POD = postoperative day POM = postoperative month RIRS = retrograde intrarenal surgery SFR = stone-free rate SWL = shock wave lithotripsy Objectives: To compare outcomes of retrograde intrarenal surgery for urolithiasis between patients with solitary kidneys and patients who have single-side urolithiasis with bilateral kidneys. Methods: We retrospectively analyzed outcomes of retrograde intrarenal surgery in solitary kidney patients (group A) carried out during 2007-2014, and in patients with bilateral kidneys with comparable stone burdens (group B). Stone-free status was defined as no residual fragment on computed tomography 1 month later. Results: There were 19 patients in group A (mean age 62.5 AE 18.4 years, range 14-76 years). The mean stone diameter and burden were 6.0 mm (range 3-24 mm) and 10.42 AE 6.92 mm, respectively. The stone-free rate was 94.7%, and no repeat procedure was required. The glomerular filtration rate tended to rise post-surgery (postoperative day 1: 48.67 AE 15.92 mL/min, 100.2%, P = 0.940; postoperative month 1: 51.32 AE 16.90 mL/min, 105.7%, P = 0.101) compared with preoperative rates. The stonefree rate and surgery time were not significantly different between the two groups, although post-surgical hospitalization time was longer for group A (4.05 vs 3.08 days, P = 0.037). The change in glomerular filtration rate was not significantly different between groups A and B (postoperative day 1: +0.101 vs +0.547 mL/min, respectively, P = 0.857; postoperative month 1: +2.749 vs 3.161 mL/min, respectively, P = 0.882). No significant difference was found in terms of complication rate. Conclusions: Retrograde intrarenal surgery in solitary kidney patients is as safe and effective as in bilateral kidney patients.

Percutaneous nephrolithotomy versus retrograde intrarenal surgery for the treatment of kidney stones up to 2 cm in patients with solitary kidney: a single centre experience

“…They may cause urinary tract infection, anuria, renal insufficiency or sepsis [1]. Therefore, stones in patients with solitary kidney need active treatment.…”

“…Therefore, stones in patients with solitary kidney need active treatment. The management of stones in this cohort as yet remains a challenging scenario, complete removal of the stone and protection of the renal function through safely surgical treatments is critical [1, 2]. …”

“…In patients contraindicated for PCNL and with unfavorable treatment characteristics, such as morbid obesity, advanced vertebral deformities, serious cardiopulmonary diseases or those receiving anticoagulant treatment, RIRS is a reliable choice [3]. Which is a preferable treatment method for preserving functioning renal parenchyma [2], and this is crucial to the management of patients with solitary kidney [1]. Unfortunately, RIRS cannot be recommended as first-line treatment due to which stone-free rate (SFR) showed a negative correlation with stone size [7].…”

“…In addition, one concern about performing RIRS in a solitary kidney is the risk of renal function injury. Recently, Kuroda and coworkers [1] have shown that no significant difference was found in term of the change in glomerular filtration rate after RIRS between patients with solitary kidney and bilateral kidneys.…”

Solitary kidney – a clinical challenge for endourologist

“…Furthermore, Ghosh and Somani showed that URS in the solitary kidney may be performed harmless as a day-case procedure [ 4 ]. In a recent study, Kuroda et al found that RIRS for <2 cm calculi in solitary kidney patients is as safe as in bilateral kidney patients [ 5 ]. Moreover, the preferred procedure is often implemented with the special concern to avoid any possible complications.…”