Percutaneous nephrolithotomy in patients with solitary kidney: a critical outcome analysis

Abstract

Purpose:To describe our experience with percutaneous nephrolithotomy (PCNL) in patients with solitary kidneys and analyze factors that can impact on intra-operative bleeding and postoperative complications.Materials and Methods:We reviewed our stone database searching for patients with solitary kidney who underwent PCNL from Jan-05 through Oct-13. Demographic data, stone characteristics, and intra- and postoperative outcomes were recorded. Spearman correlation was performed to assess which variables could impact on bleeding and surgical complications. Linear and logistic regressions were also performed.Results:Twenty-seven patients were enrolled in this study. The mean age and BMI were 45.6 years and 28.8Kg/m2, respectively; 45% of cases were classified as Guys 3 (partial staghorn or multiple stones) or 4 (complete staghorn) – complex cases. Stone-free rate was 67%. Eight (29.6%) patients had postoperative complications (five of them were Clavien 2 and three were Clavien 3). On univariate analysis only number of tracts was associated with increased bleeding (p=0.033) and only operative time was associated with a higher complication rate (p=0.044). Linear regression confirmed number of access tracts as significantly related to bleeding (6.3, 95%CI 2.2-10.4; p=0.005), whereas logistic regression showed no correlation between variables in study and complications.Conclusions:PCNL in solitary kidneys provides a good stone-free rate with a low rate of significant complications. Multiple access tracts are associated with increased bleeding.

Predictive Factors of Complications of PNL in Solitary Kidney: A Prospective Study.

“…El-Nahas et al found that only functioning kidney, staging stones, more than one tract, and an inexperienced operator were a causes for renal hemorrhage (26). Torricelli also found that a second dilatation of the tract was significantly associated with bleeding (24). In our study, there was a slight increase in the postoperative serum creatinine after one day.…”

“…This is since acute dilatation of the tract was done in most of the cases (78%). In literature, the operative time was positively correlated to the complication rate (24). Only 12 (8%) patients required blood transfusion in this study.…”

One week pre-operative oral antibiotics for percutaneous nephrolithotomy reduce risk of infection: a systematic review and meta-analysis

“…Several possible risk factors for infection were investigated. Patient positioning in PCNL, tract size, obesity and solitary kidney do not seem to impact infectious rates (11)(12)(13)(14). Some investigators consider high risk for infection stone size ≥ 20 mm and/or dilation of the collecting system with sterile urine.…”

Changes in renal volume post Percutaneous nephrolithotomy based on ultrasonography and its correlation with glomerular filtration rate (GFR)

“…Fact is many studies have also shown no deleterious effects of PCNL on the renal function, even in multiple access procedures and patients with solitary kidneys. 4,[6][7][8] Such studies mainly focused only on laboratory parameters such as glomerular filtration rate (GFR) or serum creatinine (Cr), which are greatly altered by patient factors like body mass index, race and sex. Few studies used nuclear renography which is based on radioisotope uptake, which is costly and not readily available.…”