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Organo Oficial de la Sociedad Mexicana de Urología

2024, Number 6

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Rev Mex Urol 2024; 84 (6)

Endourological management in single kidney: is percutaneous nephrolithotomy a safe procedure for complex stones?

Monzón FJF, Flores TJP, Esqueda MA, Cruz NE

Language: Spanish
References: 17
Page: 1-11
PDF size: 140.98 Kb.


ABSTRACT

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

  1. Osther PJS. Risks of flexible ureterorenoscopy:pathophysiology and prevention. Urolithiasis. 2018;46(1): 59–67. https://doi.org/10.1007/s00240-017-1018-6.

  2. Khan SR, Pearle MS, Robertson WG, GambaroG, Canales BK, Doizi S, et al. Kidney stones.Nature Reviews. Disease Primers. 2016;2: 16008.https://doi.org/10.1038/nrdp.2016.8.

  3. Sorokin I, Mamoulakis C, Miyazawa K,Rodgers A, Talati J, Lotan Y. Epidemiology ofstone disease across the world. World Journal ofUrology. 2017;35(9): 1301–1320. https://doi.org/10.1007/s00345-017-2008-6.

  4. Fang Y, Liu Y, Huang H, Zhang G, Zou X, XieT. Analysis of risk factors for SIRS after PCNLin patients with solitary kidney. Urolithiasis.2024;53(1): 10. https://doi.org/10.1007/s00240-024-01681-1.

  5. Gao X, Fang Z, Lu C, Shen R, Dong H,Sun Y. Management of staghorn stones inspecial situations. Asian Journal of Urology.2020;7(2): 130–138. https://doi.org/10.1016/j.ajur.2019.12.014.

  6. Karkin K, Erçil H. Is percutaneousnephrolithotomy effective and safe forchildren with solitary kidney? Pediatric SurgeryInternational. 2022;38(8): 1171–1175. https://doi.org/10.1007/s00383-022-05147-6.

  7. Bucuras V, Gopalakrishnam G, Wolf JS, SunY, Bianchi G, Erdogru T, et al. The ClinicalResearch Office of the Endourological SocietyPercutaneous Nephrolithotomy GlobalStudy: nephrolithotomy in 189 patients withsolitary kidneys. Journal of Endourology.2012;26(4): 336–341. https://doi.org/10.1089/end.2011.0169.

  8. Zhang Y, Wu Y, Li J, Zhang G. Comparison ofPercutaneous Nephrolithotomy and RetrogradeIntrarenal Surgery for the Treatment of LowerCalyceal Calculi of 2-3 cm in Patients WithSolitary Kidney. Urology. 2018;115: 65–70.https://doi.org/10.1016/j.urology.2017.11.063.

  9. Pietropaolo A, Reeves T, AboumarzoukO, Kallidonis P, Ozsoy M, Skolarikos A,et al. Endourologic Management (PCNL,URS, SWL) of Stones in Solitary Kidney: ASystematic Review from European Associationof Urologists Young Academic Urologists andUro-Technology Groups. Journal of Endourology.2020;34(1): 7–17. https://doi.org/10.1089/end.2019.0455.

  10. Suárez-Ibarrola AHRR. Manejo de litiasis renalcon nefrolitotomía percutánea: experiencia deun hospital de referencia. Revista Mexicana deUrología. 2014;74(4). https://doi.org/10.48193/revistamexicanadeurologa.v74i4.188.

  11. Haberal HB, Çıtamak B, Bozacı AC,Yazıcı MS, Aki FT, Bilen CY. PercutaneousNephrolithotomy in Solitary Kidneys: 17 Yearsof Experience. Urology. 2017;109: 55–59.https://doi.org/10.1016/j.urology.2017.07.038.

  12. Medina-Escobedo M, Alcocer-Dzul R, López-López J, Villanueva-Jorge S. Obesidad comofactor de riesgo para alteraciones metabólicas enadultos con litiasis urinaria. Revista Médica delInstituto Mexicano del Seguro Social. 2015;53(6):692–697.

  13. Basulto-Martínez M, Peña-Espinoza B, Valdez-Ortiz R, Escalante-Sosa R, Flores-Tapia JP,Menjivar M. High Prevalence of Hypocitraturiain Stone Formers from the Maya Region ofYucatan, Mexico. Archives of Medical Research.2022;53(1): 69–78. https://doi.org/10.1016/j.arcmed.2021.05.006.

  14. Abufaraj M, Xu T, Cao C, Waldhoer T, SeitzC, D’andrea D, et al. Prevalence and Trendsin Kidney Stone Among Adults in the USA:Analyses of National Health and NutritionExamination Survey 2007-2018 Data. EuropeanUrology Focus. 2021;7(6): 1468–1475. https://doi.org/10.1016/j.euf.2020.08.011.

  15. Shi X, Peng Y, Li L, Li X, Wang Q, Zhang W,et al. Renal function changes after percutaneousnephrolithotomy in patients with renal calculiwith a solitary kidney compared to bilateralkidneys. BJU international. 2018;122(4): 633–638. https://doi.org/10.1111/bju.14413.

  16. El-Nahas AR, Shokeir AA, El-Assmy AM,Mohsen T, Shoma AM, Eraky I, et al. Postpercutaneousnephrolithotomy extensivehemorrhage: a study of risk factors. The Journalof Urology. 2007;177(2): 576–579. https://doi.org/10.1016/j.juro.2006.09.048.

  17. Liu C, Cui Z, Zeng G, Wan SP, Li J, Zhu W, et al.The optimal minimally invasive percutaneousnephrolithotomy strategy for the treatment ofstaghorn stones in a solitary kidney. Urolithiasis.2016;44(2): 149–154. https://doi.org/10.1007/s00240-015-0803-3.




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