Aim: To present our experience of performing percutaneous nephrolithotomy (PNL) in solitary kidneys with or without renal failure, and assessing the postoperative complications and importance of nadir serum creatinine as marker of long-term renal function.
Materials and Methods: In a retrospective study, the records of 28 patients with solitary functioning kidney (N = 12) or congenital solitary kidney (N = 16) underwent PNL between January 2004 to July 2012 were analyzed. Mild renal failure (creatinine: 1.6 to 3.0 mg %) was present in 4 patients and moderate renal failure (creatinine: 3.1 to 6.0 mg %) was present in 8 patients. Internal ureteral stenting was performed in renal failure cases, except in 4 patients who required percutaneous nephrostomy and had moderate renal failure with infected hydronephrosis. Diabetes mellitus and/or hypertension were present in 9 patients. Complete stone clearance was achieved in all except 2 cases, which had clinically significant residue (CSR) of 8 mm. Both these required shock-wave lithotripsy (SWL) and they were stone free at 4 weeks. The patients were followed up with serum creatinine and a renal ultrasound.
Results: Gross hematuria requiring blood transfusion was observed in 4 patients. All these patients initially presented with moderate renal failure, infected hydronephrosis, diabetes mellitus, and hypertension. The median follow-up was 42.5 months. The nadir serum creatinine followed internal stenting or nephrostomy if it remained above the baseline; it failed to touch the normal level following PNL.
Conclusion: PNL in solitary functioning or congenitally solitary kidneys is a safe and effective procedure. The bleeding is the commonest complication, and it can be managed conservatively. The nadir serum creatinine remains the most important predictor of long-term renal function.
KEYWORDS: Percutaneous nephrolithotomy, solitary kidney, predictor of renal function
CORRESPONDENCE: Vishwajeet Singh, MS, MCh (Urology), Chhatrapati Shahuji Maharaj Medical University (Formerly KGMC), Lucknow, Uttar Pradesh, India ( )
CITATION: UroToday Int J. 2012 December;5(6):art 60.
DOI: http://dx.doi.org/10.3834/uij.1944-5784.2012.12.05
