Caglayan Volkan, Oner Sedat, Onen Efe, Avci Sinan, Aydos Murat, Kilic Metin, Demirbas Murat
Department of Urology, University of Medical Sciences Bursa, Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey -
Department of Urology, University of Medical Sciences Bursa, Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.
Minerva Urol Nefrol. 2018 Oct;70(5):518-525. doi: 10.23736/S0393-2249.18.03123-5. Epub 2018 May 14.
To evaluate success and complication rates of endourological stone treatments and to evaluate effects of percutaneous nephrolithotomy (PCNL) on renal functions, in patients with solitary kidneys.
In our center, 3150 patients underwent PCNL between 2003 and 2017 and 142 patients underwent retrograd intrarenal surgery (RIRS) between 2013 and 2017. We retrospectively analysed the data of 82 patients with solitary kidney who underwent PCNL and of 8 patients with solitary kidney who underwent RIRS. Complications were classified according to Clavien-Dindo Classification system. Serum creatinin was measured before the procedure, on the early postoperative period and at sixth month follow-up in PCNL group. The estimated glomerular filtration rate (eGFR) was calculated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. The 5-stage classification of chronic kidney disease (CKD) was used according to the National Kidney Foundation guideline.
In the PCNL group, the initial stone-free and success rates were 82.9% and 95.1%, respectively. Complications occured in 18 (22%) patients. Transfusion was the most common complication (15.5%). One patient required JJ stenting. The stone-free rates of the patients who required multiple accesses were statistically lower than the patients who required single access (P=0.01). Transfusion rates were statistically higher in patients who required multiple accesses and who had complex stones (P=0.01 and P=0.02, respectively). GFRs calculated preoperatively, in the early and in the late period were 65.03, 62.85 (P=0.224) and 70.63 mL/min/1.73 m2 (P<0.001), respectively. At the postoperative 6th month, GFR was stable in CKD stage 1 patients and improved in CKD stage 2-4 patients (P<0.001, P<0.001 and P=0.012 respectively). In the RIRS group, 5 patients (62.5%) were stone free and the success rate was 75% (6 patients) after single procedure. Any complication did not occur in the RIRS group.
PCNL in solitary kidney is a safe method with acceptable complication rates. Renal functions are preserved in patients with normal functioning kidney and improved in patients with renal insufficiency. RIRS may be an alternative method in selected patients with solitary kidney.
评估腔内泌尿外科结石治疗的成功率和并发症发生率，并评估经皮肾镜取石术（PCNL）对孤立肾患者肾功能的影响。
在我们中心，2003年至2017年间有3150例患者接受了PCNL，2013年至2017年间有142例患者接受了逆行肾内手术（RIRS）。我们回顾性分析了82例接受PCNL的孤立肾患者和8例接受RIRS的孤立肾患者的数据。并发症根据Clavien-Dindo分类系统进行分类。在PCNL组中，于术前、术后早期及术后6个月随访时测定血清肌酐。使用慢性肾脏病流行病学协作组（CKD-EPI）公式计算估计肾小球滤过率（eGFR）。根据美国国立肾脏基金会指南采用慢性肾脏病（CKD）的5期分类法。
在PCNL组中，初始无石率和成功率分别为82.9%和95.1%。18例（22%）患者发生并发症。输血是最常见的并发症（15.5%）。1例患者需要置入双J管。需要多次穿刺的患者的无石率在统计学上低于需要单次穿刺的患者（P=0.01）。需要多次穿刺和患有复杂结石的患者的输血率在统计学上更高（分别为P=0.01和P=0.02）。术前、早期和晚期计算的GFR分别为65.03、62.85（P=0.224）和70.63 mL/min/1.73 m²（P<0.001）。术后6个月时，CKD 1期患者的GFR稳定，CKD 2-4期患者的GFR有所改善（分别为P<0.001、P<0.001和P=0.012）。在RIRS组中，5例（62.5%）患者无结石残留，单次手术后成功率为75%（6例）。RIRS组未发生任何并发症。
孤立肾患者行PCNL是一种安全的方法，并发症发生率可接受。肾功能正常的患者肾功能得以保留，肾功能不全的患者肾功能得到改善。RIRS可能是部分孤立肾患者的替代方法。
