The effectiveness and safety of percutaneous nephrolithotomy (PCNL) for solitary kidneys: A single-center experience

ABSTRACT

OBJECTIVE: To evaluate the outcomes of percutaneous nephrolithotomy in patients with solitary kidneys. METHODOLOGY: Between January 2009 and December 2013, 31 patients with renal stones in solitary kidneys were treated with PCNL. All stones were diagnosed using an unenhanced CT scan. The solitary functioning status of the kidney was congenital absence of the contralateral kidney in 7(22%); opposite nephrectomy in 15(48%); and nonfunctional contralateral kidneys in 9(29%) as detected by nuclear scintigraphy. The serum creatinine and hemoglobin were monitored at regular intervals. The stones were classified using the Guy Stone Score while the complications were analyzed using the Clavien-Dindo Grading System. The mean follow-up in months was 21.3±12.26 (4-48). RESULTS: The male to female ratio is 1.2:1. According to the Guy Stone Score, the stones were Grade 1 in 54.8% (17/31), Grade 2 in 16.1% (5/31), Grade 3 in 6.4% (2/31) and Grade 4 in 22.5% patients, respectively. The stone-free status was determined with a postop CT scan. Complete stone clearance was achieved in 90.3% (28/31) after a single session of PCNL. The mean operative time was 151±36.7(90-230) minutes. According to the Clavien-Dindo Classification, 19 (59.3%) had no complication, 4 (12.9%) had Grade 1 (fever), 7 (29.2%) had Grade 2 (blood transfusion) and 1(3%) had Grade 5 (postoperative hemodialysis, sepsis and death). The rest had stable or improved renal function without postoperative hemodialysis. The mean rise in serum creatinine was 0.67±1.01 (0.1-3.5) mg/dL. Mean drop in hemoglobin was 1.6±0.89(0.5-3.8) gm/dL. CONCLUSION: PCNL is effective and safe for patients with nephrolithiasis in solitary kidneys. This minimally invasive procedure achieves a high stone clearance rate with acceptably low morbidity and mortality.