Purpose: To report our experience with total ultrasound-guided percutaneous nephrolithotomy (PCNL) in the management of patients with solitary kidney, and evaluate the safety and feasibility of this technique.
Materials and methods: Between October 2014 and December 2016, 48 patients with solitary kidneys underwent total ultrasound-guided PCNL at our institution. Stone-free rate (SFR), auxiliary procedures, and complications were recorded. Changes in renal function were evaluated by comparing preoperative and postoperative estimated glomerular filtration rates (eGFRs). Perioperative factors that may affect renal function were analyzed to define factors predicting renal function improvement on long-term follow-up. Of 48 patients, 44 were followed at least 6 months, whereas four patients were lost to follow-up.
Results: Among all patients, staghorn calculi were found in 18 (37.5%) patients. 14 (29.2%) patients required a two-stage PCNL. Struvite was found in six (12.5%) patients. Complications were reported in eight (16.7%) patients. Severe bleeding was noticed in three patients; no angioembolization was required. After a median follow-up of 12 (6-26) months, the final SFR was 81.8% after auxiliary treatments. There was a significant improvement of eGFR from 53.9 ± 24.0 to 61.3 ± 25.4 mL/min/1.73 m2 (P < 0.01). Renal function was stable, improved and worse in 65.9% (n = 29), 27.3% (n = 12), and 6.8% (n = 3) of patients, respectively, compared with preoperative levels.
Conclusions: Ultrasound-guided PCNL is a safe and feasible procedure with an acceptably low complication rate in patients with solitary kidneys. At long-term follow-up, the renal function in more than 90% of the patients with solitary kidneys can be improved or stabilized after ultrasound-guided PCNL.
Keywords: PCNL; Solitary kidney; Ultrasound guidance.