Nationwide Readmission Rates Following Percutaneous Nephrolithotomy: Does Age Matter?

Introduction/Objectives: Despite minimal evidence that evaluates the effect of age on percutaneous nephrolithotomy (PCNL) morbidity, pediatric and elderly patients are considered high-risk groups. Our objective was to assess the effect of the extremes of ages on PCNL readmission and postoperative complication rates. Methods: We identified all PCNL encounters in the 2013 and 2014 Nationwide Readmission Database. Encounters were divided into five age groups: pediatric (<18 years old), young adult (18-25 years old), adult (26-64 years old), geriatric (65-74 years old), and elderly (≥75 years old). Weighted descriptive statistics were used to describe population demographics. We fit an adjusted weighted logistic regression model for 30-day readmission and complication rates. Results: We identified 23,357 encounters. Testing average effect of pediatric and elderly encounters to all other age groups did not reveal a difference in odds for 30-day readmissions, but did result in increased odds for 30-day GU readmissions (odds ratio: 17.7 [95% confidence interval (CI): 2.65-118.9]; p = 0.003). Compared to all other age groups, elderly encounters had 7.5 (95% CI: 2.5-22.7; p = 0.0004) times the odds of a 30-day readmission and 68.3 (95% CI: 29.1-160.4; p < 0.0001) times the odds of a postoperative complication. Conclusions: When comparing the average effect of the extremes of ages to all other age groups, we did not find evidence to suggest a difference in odds for 30-day GU readmissions, but did find increased odds for complications. Further examination revealed that PCNL encounters of elderly patients had significantly increased odds for both readmission and complications, whereas PCNL encounters of pediatric patients did not.

Is extracorporeal shockwave lithotripsy a risk factor for the development of diabetes mellitus? A population-based study.

OBJECTIVE: To determine if patients treated with extracorporeal shockwave lithotripsy (ESWL) are at a greater risk of developing diabetes mellitus (DM) than those treated with ureteroscopy (URS). PATIENTS AND METHODS: A retrospective population-based cohort study was performed of all ESWL and URS stone treatments done in Ontario between January 1994 and March 2014, utilising linked encoded healthcare databases. The primary outcome was the development of DM >90 days after treatment. The Kaplan-Meier method was used for unadjusted survival analysis and multivariable analysis with Cox proportional hazards regression was used to assess the risk of DM between the ESWL and URS groups whilst controlling for age, gender, region of residence, income quintile, year of treatment, and comorbidity index. A sensitivity analysis with a subset of ESWL patients treated for left renal or proximal ureteric stones was completed. RESULTS: We identified 106 963 patients who underwent ESWL or URS over the study period with a median follow-up of 6.6 years (ESWL 8.5 years, URS 5.6 years). Unadjusted survival analysis showed an increased risk of developing DM in the ESWL group compared to the URS group (P < 0.001); however, multivariable analysis showed no increased risk of DM in the ESWL cohort (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.91-1.02; P = 0.25). Similarly, sensitivity analysis showed no increased risk of DM in the left renal/proximal ureteric stone ESWL cohort compared to the URS cohort (HR 1.04, 95% CI 0.96-1.13; P = 0.35). CONCLUSIONS: Our population-based cohort study demonstrated no increased risk of DM in patients undergoing ESWL compared to URS.

Mortality from kidney stone disease (KSD) as reported in the literature over the last two decades: a systematic review.

INTRODUCTION: Current trends show a rising incidence of kidney stone disease (KSD) globally, with a lifetime risk of 10% and increasing hospital admissions. However, it is not perceived as a life-threatening condition and there are no publications examining its mortality rate. The aim of this review was to report on the number of KSD mortalities in the literature from the past two decades, identify risk factors, and to summarize their key learning points. METHODS: A search was conducted for full-text English language articles that reported on KSD associated mortality, following intervention or conservative treatment, published between 1999 and 2017, using PubMed, MEDLINE, EMBASE, Scopus, CINAHL, Clinicaltrials.gov, Google Scholar and The Cochrane Library. Study quality and risk of bias assessment was undertaken using a validated critical appraisal tool from the Joanna Briggs Institute. RESULTS: Of the 2786 articles identified, 34 were included. Of the total number of reported mortalities (2550), 21% were related to intervention. Sepsis was the leading cause of mortality. Risk factors identified were patients with multiple co-morbidities, spinal cord injury or neurogenic bladder and high stone burden. The main recommendations suggested were to treat pre-operative UTI or use prophylactic antibiotics and to reduce operative duration. The included studies were of moderate to good quality. CONCLUSION: Pre-procedural optimization of the patients is the key to avoiding KSD mortality, and care should be taken in patients with multiple co-morbidities. Surgeons should meticulously plan for patients with high stone burden to reduce their operative time, as mortality can be procedural related.

Evaluation and Management of Kidney Calculi.

INTRODUCTION: The recent change in the view towards nephrolithiasis from a benign isolated disease to a disorder associated with numerous systemic and chronic conditions has added to the importance of a more thorough and timely diagnostic and therapeutic intervention. MATERIALS AND METHODS: Both original and review articles found via the PubMed search on recent evaluation and management strategies of urinary calculi were reviewed. These resources were integrated with the authors' knowledge of the field. RESULTS: The emerging evidence attests to the association of nephrolithiasis with many morbid and fatal diseases, such as coronary heart disease, ischemic stroke, hypertension, chronic kidney insufficiency, malignancies, and bone loss, as well as the economic burden of urinary calculus on health system and work force. CONCLUSIONS: Findings of this review justify a timely and comprehensive workup and dietary-therapeutic measures in order to prevent, treat, and control the associated complications of this condition.

Upper urinary tract stone disease in patients with poor performance status: active stone removal or conservative management?

BACKGROUND: It remains controversial as to whether active stone removal should be performed in patients with poor performance status because of their short life expectancy and perioperative risks. Our objectives were to evaluate treatment outcomes of active stone removal in patients with poor performance status and to compare life prognosis with those managed conservatively. METHODS: We retrospectively reviewed 74 patients with Eastern Cooperative Oncology Group performance status 3 or 4 treated for upper urinary tract calculi at our four hospitals between January 2009 and March 2016. Patients were classified into either surgical treatment group or conservative management group based on the presence of active stone removal. Stone-free rate and perioperative complications in surgical treatment group were reviewed. In addition, we compared overall survival and stone-specific survival between the two groups. Cox proportional hazards analysis was performed to investigate predictors of overall survival and stone-specific survival. RESULTS: Fifty-two patients (70.3%) underwent active stone removal (surgical treatment group) by extracorporeal shock wave lithotripsy (n = 6), ureteroscopy (n = 39), percutaneous nephrolithotomy (n = 6) or nephrectomy (n = 1). The overall stone-free rate was 78.8% and perioperative complication was observed in nine patients (17.3%). Conservative treatment was undergone by 22 patients (29.7%) (conservative management group). Two-year overall survival rates in surgical treatment and conservative management groups were 88.0% and 38.4%, respectively (p < 0.01) and two-year stone-specific survival rates in the two groups were 100.0% and 61.3%, respectively (p < 0.01). On multivariate analysis, stone removal was not significant, but was considered a possible favorable predictor for overall survival (p = 0.07). Moreover, stone removal was the only independent predictor of stone-specific survival (p < 0.01). CONCLUSIONS: Active stone removal for patients with poor performance status could be performed safely and effectively. Compared to conservative management, surgical stone treatment achieved longer overall survival and stone-specific survival.

Mortality and flexible ureteroscopy: analysis of six cases.

PURPOSE: Advancements in the endourological equipment have made retrograde intrarenal surgery (RIRS) an attractive, widespread technique, capable of competing with traditional shock wave lithotripsy and percutaneous nephrolithotomy. Since the complication rate is generally low, even less is known about dramatic and fatal complications after RIRS. METHODS: We performed a survey asking 11 experienced endourologists to review their RIRS series and report the cases of mortality to their best knowledge. RESULTS: Six urologists reported on six fatal cases. In three cases, a history of urinary tract infections was present. Four patients died from urosepsis, one due to an anesthetic and one due to hemorrhagic complication. The use of ureteral access sheath was not common. CONCLUSION: Even respecting the standards of care, it may happen that physicians are occasionally tempted to overdo for their patients, sometimes skipping safety rules with an inevitable increase in risks. Despite the fact that RIRS has become a viable option for the treatment of the majority of kidney stones, its complication rates remain low. Nevertheless, rare fatal events may occur, especially in complex cases with a history of urinary tract infections, and advanced neurological diseases.

Risk Factors for Postoperative Complications of Percutaneous Nephrolithotomy at a Tertiary Referral Center.

PURPOSE: We sought to describe and evaluate the complications related to percutaneous nephrolithotomy and identify risk factors of morbidity according to the modified Clavien scoring system. We also sought to specify which perioperative factors are associated with minor and major complications. MATERIALS AND METHODS: We retrospectively analyzed data on patients who underwent percutaneous nephrolithotomy from 1990 to 2013. Descriptive statistics were used to analyze patient characteristics, medical comorbidities and perioperative features. Complications were categorized according to the Clavien score for percutaneous nephrolithotomy. The Mann-Whitney and Fisher exact tests were used as appropriate. Logistic regression analysis was performed to look for prognostic factors associated with major complications. RESULTS: A total of 2,318 surgeries were evaluated. Mean age of the population was 53.7 years. The stone-free rate at hospital discharge was 81.6%. The overall complication rate was 18.3%. Two deaths occurred. Patients with any postoperative complications were older, had more comorbidities, were more likely to have staghorn calculi and had longer operative time and hospital stay on univariate analysis (p<0.05). Age 55 years or older and upper pole access were independent predictors of major complications on multivariate analysis. Other factors such as a history of urinary tract infections, body mass index, stone composition, previous percutaneous nephrolithotomy and multiple tracts were not associated with a major complication. CONCLUSIONS: At our center percutaneous nephrolithotomy is an excellent option for complex kidney stone management with a low overall complication rate. Older patient age and upper pole access are significantly associated with an increased risk of a major complication.

Percutaneous nephrolithotomy in England: practice and outcomes described in the Hospital Episode Statistics database.

OBJECTIVE: To investigate the postoperative outcomes of percutaneous nephrolithotomy (PCNL) in English National Health Service (NHS) hospitals. PATIENTS AND METHODS: We extracted records from the Hospital Episode Statistics (HES) database for all patients undergoing PCNL between March 2006 and January 2011 in English NHS hospitals. Outcome measures were haemorrhage, infection within the index admission, and rates of emergency readmission and in-hospital mortality within 30 days of surgery. RESULTS: A total of 5750 index PCNL procedures were performed in 165 hospitals. During the index admission, haemorrhage was recorded in 81 patients (1.4%), 192 patients (3.8%) had a urinary tract infection (UTI), 95 patients (1.7%) had fever, and 41 patients (0.7%) had sepsis. There were 595 emergency readmissions in 518 patients (9.0%). Reasons for readmission were varied: 70 (1.2%) with UTI, 15 (0.3%) sepsis, 73 (1.3%) haematuria, 25 (0.4%) haemorrhage, and 25 (0.4%) acute urinary retention. There were 13 (0.2%) in-hospital deaths within 30 days of surgery. CONCLUSIONS: Haemorrhage and infection represent relatively common and potentially severe complications of PCNL. Mortality is extremely rare after PCNL (about one in 400 procedures overall) but almost one in 10 patients have an unplanned hospital readmission within 30 days of surgery. Complications of PCNL may be under-reported in the HES database and need to be corroborated using other data sources.

Kidney stones and cardiovascular events: a cohort study.

BACKGROUND AND OBJECTIVES: Kidney stones are common in general clinical practice, and their prevalence is increasing. Kidney stone formers often have risk factors associated with atherosclerosis, but it is uncertain whether having a kidney stone is associated with higher risk of cardiovascular events. This study sought to assess the association between one or more kidney stones and the subsequent risk of cardiovascular events. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Cohort study of 3,195,452 people aged≥18 years registered in the universal health care system in Alberta, Canada, between 1997 and 2009 (median follow-up of 11 years). People undergoing dialysis or with a kidney transplant at baseline were excluded. The primary outcome was the first acute myocardial infarction (AMI) during follow-up. We also considered other cardiovascular events, including death due to coronary heart disease, percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass grafting (CABG), and stroke. RESULTS: In total, 25,532 (0.8%) participants had at least one kidney stone, and 91,465 (3%) individuals had at least one cardiovascular event during follow-up. Compared with people without kidney stones and after adjustment for cardiovascular risk factors and other potential confounders, people who had at least one kidney stone had a higher risk of subsequent AMI (adjusted hazard ratio [HR], 1.40; 95% confidence interval [95% CI], 1.30 to 1.51), PTCA/CABG (HR, 1.63; 95% CI, 1.51 to 1.76), and stroke (HR, 1.26; 95% CI, 1.12 to 1.42). The magnitude of the excess risk associated with a kidney stone appeared more pronounced for younger people than for older people (P<0.001) and for women than men (P=0.01). CONCLUSIONS: The occurrence of a kidney stone is associated with a higher risk of cardiovascular events, including AMI, PTCA/CABG, and stroke.

The clinical profile and prognosis of Chinese children with melamine-induced kidney disease: a systematic review and meta-analysis.

INTRODUCTION: Studies have reported inconsistent results regarding clinical feature and the prognosis status of the affected children in China melamine-contamination event. We summarized available literatures by performing a review and meta-analysis. METHODS: Statistical pooling was performed using random-effects model; the sources of heterogeneity were explored through subgroup analyses. RESULTS: Twenty-six studies involving 2164 patients with kidney abnormalities were identified; 94.4% of the patients had urinary calculi and 95.8% of the calculi were < 10 mm in diameter. Of 2040 patients with known types of treatment, 5.6% underwent surgical treatment. The pooled recovery rates at 1, 3, 6, and 12 months after diagnosis or treatment initiation were 67.1%, 76.3%, 85.4%, and 92.3%, respectively; these pooled rates did not differ between the study subgroups stratified by mean age at diagnosis, mean duration of melamine exposure, types of patients (inpatient/outpatient), and treatment types (specific/nonspecific), except that the 1-month recovery rate for studies involving a specific treatment (71.9%) was higher than that for studies involving non-specific treatment (46.2%). CONCLUSION: The majority of patients had small calculi and could recover without surgical treatment. Kidney abnormalities remained in about 8% of the patients at 12-month followup, indicating a need for longer-term followup.

The association of prevalent kidney stone disease with mortality in US adults: the National Health and Nutrition Examination Survey III, 1988-1994.

BACKGROUND: Kidney stone disease is associated with hypertension, diabetes, metabolic syndrome, kidney function decline, and increased cardiovascular (CV) events. However, its association with all-cause and CV mortality is unclear. METHODS: We used the Third National Health and Nutrition Examination Survey, a large US population-based study with mortality data through 2006 determined via linkage to the National Death Index to examine kidney stone disease in relation to all-cause and CV mortality risks. RESULTS: Among 14,879 men and women over 18 years of age who were eligible for analysis, 683 participants reported a history of kidney stones. There was a total of 3,590 all-cause and 1,608 CV deaths during a median follow-up of 14.9 years. Stone formers had a significantly higher risk for all-cause mortality [hazard ratio (HR): 1.95, 95% CI: 1.64-2.33, p < 0.0001) and CV mortality (HR: 2.05, 95% CI: 1.60-2.62, p < 0.0001) in unadjusted analyses. However, after multivariate adjustment for age, gender, race, and poverty, stone formers no longer had increased risk for all-cause mortality (HR: 1.08, 95% CI: 0.93-1.26, p = 0.3) and CV mortality (HR: 1.07, 95% CI: 0.84-1.36, p = 0.6). Results remain unchanged after further adjustment for other clinical variables including history of hypertension, diabetes, and CV disease. CONCLUSION: The increased risk of all-cause and CV mortality in kidney stone formers is likely a reflection of unique demographics and associated comorbidities. There is no independent association of prevalent kidney stone disease with all-cause and CV mortality.

Charlson comorbidity index and success of extracorporeal shock wave lithotripsy.

INTRODUCTION/OBJECTIVE: We examined the potential correlation between Charlson comorbidity index (CCI) and stone free rate after extracorporeal shock wave lithotripsy (ESWL). MATERIALS AND METHODS: Two hundred twenty-six adult patients were treated with 241 ESWL procedures for a renal or ureteral stone(s) over a 3 year period. Age, race, comorbidities, CCI, stone size and location, number of shocks and power level were determined. Treatment efficacies were evaluated at a mean of 56.1 days after each ESWL with computed tomography, abdominal x-ray, intravenous pyleography and/or renal ultrasound. Multivariate logistic regression analysis was performed. RESULTS: There was no correlation between CCI and any of the following: stone burden, number of shocks, or power level. There was no difference in stone burden, number of shocks or power level between those who were and were not stone free. Stone free rates for patients with CCI of zero, one, and two or greater were 44.7% (71/159), 27% (13/48) and 41.2% (14/34) respectively. Patients with an index of one were 2.1 times more likely to have a residual stone burden than patients with an index of zero (95% CI 0.99-4.42, p = 0.05). Patients with one comorbidity were 2.4 times more likely to have a residual stone burden than patients with none (95% CI 1.04-5.72, p = 0.04). Patients with upper ureteral stones were less likely to have a residual stone burden than patients with renal stones (RR = 0.52, 95% CI 0.27-0.98, p = 0.04). Those with lower ureteral stones were less likely to have a residual stone burden than those with renal stones (RR = 0.20, 95% CI 0.09-0.43, p <0.0001). The only significant predictors of the stone free rate were stone location and number of comorbidities. CONCLUSIONS: Stone location and number of comorbidities were significant predictors of ESWL outcome. The CCI may underestimate the magnitude of comorbidities and their effect on stone treatment efficacy.

Kidney stones and the risk for chronic kidney disease.

BACKGROUND AND OBJECTIVES: Kidney stones lead to chronic kidney disease (CKD) in people with rare hereditary disorders (e.g., primary hyperoxaluria, cystinuria), but it is unknown whether kidney stones are an important risk factor for CKD in the general population. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Among Olmsted County, MN, residents, all stone formers (n = 4774) whose condition was diagnosed in 1986 through 2003 were matched 1:3 to control subjects (n = 12,975). Cox proportional hazards models adjusted for age, gender, and comorbidities (hypertension, diabetes, obesity, dyslipidemia, gout, alcohol abuse, tobacco use, coronary artery disease, heart failure, cerebral infarct, and peripheral vascular disease) were used to assess the risk for incident CKD defined as a clinical diagnosis (diagnostic codes), ESRD or death with CKD, sustained (>90 d) elevated serum creatinine (>1.3 mg/dl in men, >1.1 mg/dl in women), or sustained estimated GFR <60 ml/min per 1.73 m(2). RESULTS: During a mean of 8.6 yr of follow-up, stone formers were at increased risk for a clinical diagnosis of CKD, but an increased risk for ESRD or death with CKD was NS. Among patients with follow-up serum creatinine levels, stone formers were at increased risk for a sustained elevated serum creatinine and a sustained reduced GFR. CONCLUSIONS: Kidney stones are a risk factor for CKD, and studies are warranted to assess screening and preventive measures for CKD in stone formers.

[Risks and complications of surgical treatment of urinary lithiasis of single kidney]. / Opasnosti i oslozhneniia operativnogo lecheniia bol'nykh mochekamennoi bolezn'iu edinstvennoi pochki.

163 patients with urolithiasis of the solitary kidney were treated surgically. Analysis of causes of postoperative complications (n = 70) and lethal outcomes (n = 11) demonstrate that lethal outcomes were in many cases related to exacerbation of renal failure, acute calculous pyelonephritis which had provoked sepsis and bacteriotoxic shock, acute hemorrhage with hemorrhagic shock followed by development of DIC-syndrome.

[Case statistics and life expectancy]. / Fällestatistiken und Lebenserwartung.

The trial to find connections between the frequency of cases in general medicine and life expectancy of the population succeeded, concerning superficial pyogenic infections by meta-analysing cases-statistics 1944-1996. More could be found by special, prospective, well-planned, comparable statistics of long duration, although it is unlikely that such expensive and difficult investigations will ever be made.

Single kidney outcome and management in persons with spinal cord injury.

This case study examined the outcomes of persons with spinal cord injury (SCI) who had a single kidney. A Urologic Database, including 1655 persons with SCI between 1969 and 1997, was examined and 22 persons were identified with single kidneys. Twenty persons had adequate follow-up. Renal function was measured by total and individual kidney effective renal plasma flow (ERPF). Of 11 persons who had a single kidney prior to injury or as a result of an associated injury, all maintained a normal ERPF for an average of 8.6 years. Of 9 persons who had removal of a kidney following their injury for other diseases or urinary complications, 3 were deceased, but 2 had a normal ERPF in the remaining kidney prior to death. One with vesicoureteral reflux had decreased renal function in the remaining kidney. Recurrent renal calculi in a single kidney carries risks for decreasing renal function, urosepsis, and death.

Treatment of advanced renal cell carcinoma with a combination of human lymphoblastoid interferon-alpha and cimetidine.

PURPOSE: We examined whether cimetidine could augment the efficacy of interferon-alpha therapy for advanced renal cell carcinoma. MATERIALS AND METHODS: Of 31 male and 6 female patients treated with interferon-alpha and cimetidine 21 had metastases at diagnosis and 15 had a recurrence after nephrectomy. One patient had a primary tumor with thrombus in the inferior vena cava. Lymphoblastoid interferon-alpha was administered at 5 megaunits daily intramuscularly 5 to 7 days a week for at least 8 weeks, and cimetidine was administered orally at 800 mg. daily in 4 divided doses. The evaluable tumors included 30 in the lung, 6 lymph nodes, 5 bone, 4 kidney and 1 inferior vena cava. RESULTS: Combined therapy with interferon-alpha and cimetidine resulted in a complete response in 7 patients, a partial response in 8, stable disease in 12 and progression in 10. The objective response rate was 41%. The lung metastasis showed the best response to combined therapy. The 5-year survival rates for patients with and without response, and overall were 74, 20 and 41%, respectively. Histopathologically, high grade tumors had a better response to combined therapy than did low grade tumors. CONCLUSIONS: Combined therapy with interferon-alpha and cimetidine for advanced renal cell carcinoma resulted in a definitively good response. A prospective randomized trial should be performed to elucidate the efficacy of the combined therapy.

Long-term renal fate and prognosis after staghorn calculus management.

We analyzed retrospectively 177 consecutive staghorn calculus patients to determine risk factors for ultimate renal deterioration and renal cause specific death. Mean followup was 7.7 years. Overall rate of renal deterioration was 28%. Renal deterioration was associated more frequently among patients with solitary versus nonsolitary kidneys (77% versus 21%, p < 0.001), previous versus initial stones (39% versus 14%, p = 0.03), recurrent versus nonrecurrent calculi (39% versus 22%, p = 0.07), hypertension versus normotension (50% versus 22%, p = 0.006), complete versus partial staghorn calculi (34% versus 13%, p = 0.02), diversion versus no diversion (58% versus 19%, p < 0.001) and neurogenic bladder versus normal voiding (47% versus 21%, p = 0.006), as well as those who refused treatment versus treated patients (100% versus 28%, p < 0.001). No patient with complete clearance of fragments died of renal related causes compared to 3% of those without clearance of fragments and 67% of those who refused treatment (p < 0.001). Our study suggests that long-term renal preservation in the staghorn calculus patient may depend on normal blood pressure, staghorn size, absence of diversion or voiding dysfunction, and complete stone eradication.

[Are the sequelae predictable for sectional and multiple partial nephrolithotomies of completely intrarenal coral stones? (experimental and clinical research)]. / Predskazuemy li posledstviia sektsionnoi i mnozhestvennykh partsial'nykh nefrolitotomii po povodu polnost'iu vnutripochechnykh korallovidnykh kamnei? (éksperimental'no-klinicheskoe issledovanie).

In the assessment of surgical intervention for fully intrarenal stone casts, different kinds of nephrotomies (sectional or multiple partial ones, those supplementing pyelolithotomy or performed in the kidneys with marked parenchyma) should be compared in terms of functional outcomes, severity and incidence of complications (intraoperative or postoperative bleeding from the violated kidney), postoperative urinary fistulas, aggravated renal failure and postoperative mortality. It is these milestones that have determined the scope of the present study. An experimental assessment of the degree of trauma, associated with sectional nephrolithotomy as well as its functional sequelae was made in dogs after a stone-like structure was simulated and the kidney reached the necessary degree of secretory deficiency. The comparison of pre- and postoperative renographic parameters over different spans of follow-up of animals after sectional nephrolithotomy was made to assess the latter's organ-damaging effect and, in part, functional results of surgery in a kidney with a profound functional deficiency by the time of the operation. A similar methodology was used in clinical patients, subjected to nephrolithotomy (either sectional or multiple partial procedure) for fully intrarenal coral stones. Functional results of nephrolithotomies in animals and in patients are presented in Figs 1-3. For cases where postoperative results were good or satisfactory at 1-2 months, follow-up results are presented in Tables 4-5. Postoperative complications of sectional and partial nephrolithotomies are reflected in Figs. 4-5. The incidence of paranephritis and postoperative mortality are reported in Tables 6-7. Therefore, functional results of sectional nephrolithotomy are indicative of its considerable organ-sparing effect in experimental animals. Functional outcomes of the clinical sectional and multiple partial nephrolithotomies are similar, yet partial nephrolithotomies are more detrimental to the kidney and the upper urinary tract in terms of the pattern and rate of postoperative complications, as compared to sectional nephrolithotomy. As the sequelae of sectional and partial nephrolithotomies are largely unpredictable, indications for surgical removal of intrarenal stereometrically-composite coral stones should be as limited as possible.