Background and purpose: The management of urolithiasis in patients with a solitary kidney is challenging for endourologists. This study was aimed at evaluating the safety and efficacy of retrograde intrarenal surgery (RIRS) in the treatment of such patients with renal stones.
Patients and methods: Between January 2010 and January 2014, we enrolled 45 patients who had a solitary kidney and underwent RIRS and holmium:yttrium-aluminum-garnet lithotripsy for the management of renal stones. We collected data pertaining to the preoperative patient characteristics, stone dimensions, and postoperative outcomes.
Results: Sixty-eight procedures were performed in all. The mean stone diameter was 1.84±0.19 cm (range 0.5-6.0 cm), and the mean operative time, 76.4±40.14 minutes (range 18-190 min). The percentages of patients free of renal stones at the initial and final procedures were 64.44% and 93.33%, respectively. The mean number of procedures needed for the patients with renal stones of diameters ≥20 mm and <20 mm were 1.93 per patient and 1.23 per patient, respectively (P=0.009). Postoperative complications (graded by the Clavien system) were noted in 26.6% of the patients (12/45): Grade I complications, in 20% (9/45); grade II complications, in 4.4% (2/45); and grade III complication, in 2.2% (1/45). The grade III complication was anuria because of Steinstrasse, which necessitated emergency surgery.
Conclusions: RIRS for the removal of renal stones in patients with a solitary kidney affords a high success rate and low morbidity rate. For patients with large stones, however, a multistaged approach may be needed.