Resorlu Berkan, Kara Cengiz, Oguz Ural, Bayindir Mirze, Unsal Ali
Department of Urology, Kecioren Training and Research Hospital, Kardesler Koop. 182.cad, 175. Sok., No:14/8, 06010, Etlik, Ankara, Turkey.
Urol Res. 2011 Jun;39(3):171-6. doi: 10.1007/s00240-010-0321-2. Epub 2010 Oct 22.
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.
治疗患有复杂结石的孤立肾患者是泌尿外科最具挑战性的问题之一。我们介绍了经皮肾镜取石术（PCNL）治疗16例孤立肾鹿角形结石患者的经验，以确定长期肾功能结果。我们回顾性分析了16例接受PCNL治疗的孤立肾复杂性肾盏或鹿角形结石患者的记录。研究了人口统计学数据、穿刺通道的数量和位置、血红蛋白值、结石分析以及并发症。在术前、术后1个月和1年测定血清肌酐、肾小球滤过率（GFR）、收缩压和舒张压、新发高血压以及肾脏形态。男女比例为14:2，平均年龄为49.6岁（范围31 - 55岁）。其中，10例（62.5%）患者需要单通道，而6例（37.5%）需要多通道。13例（81.3%）患者的结石成功取出或粉碎，第一阶段后实现了结石完全清除。2例残留结石患者插入双J导管并进行了体外冲击波碎石术（SWL）。除1例因扭转导致肾盂漏斗部撕裂出血的患者外，术中无明显问题。在1年的研究期内，没有患者进展到需要透析的终末期肾病。我们证明从术前到1年随访，肌酐和GFR水平有显著改善。PCNL术前有高血压的患者有5例，到随访结束时没有新发高血压。所展示的有效性、短期少量并发症以及长期随访对肾功能和血压无不良影响，证实了PCNL不仅对孤立肾鹿角形结石有效，而且安全。
