Functional and morphological recovery of solitary kidneys after drainage. Double J stent placement vs emergency ureteroscopy: which one is reasonable?

The purpose of the study was to evaluate the functional and morphological recovery of solitary kidneys following the relief of obstruction by two different approaches. Data of 65 adult patients with acute renal failure in obstructed solitary kidney were evaluated. Depending on the type of emergent decompression procedure while 34 patients were treated with a double J stent placement only 31 patients underwent ureteroscopic lithotripsy with double J stent placement. Following these procedures, in addition to the amount of excreted urine during the first 24 h, changes in the serum creatinine levels and the degree of hydronephrosis were noted and evaluated during the first week of follow-up after intervention. Evaluation of the urine output values during the first 24-h period revealed a statistically significant difference in favour of ureteroscopic lithotripsy. Serum creatinine levels in terms of the mean change in serum creatinine values and also percentage of the changes revealed no statistically significant change between two groups. Comparative evaluation of the change in the degree of hydronephrosis between baseline and post-procedural seventh day values revealed a statistically significant decrease in favour of ureteroscopic lithotripsy. Lastly, there was a statistically insignificant but meaningful difference with respect to the percent of change in the degree of hydronephrosis between two group of cases. Although temporary decompression of the obstructed solitary kidney by placing a double J stent may relieve the obstruction to a certain extent; emergent ureteroscopic lithotripsy could be applied as a reasonable alternative where adequate experience and technical availability are present.

Treatment of complex renal stones in solitary kidneys under percutaneous nephrolithotomy combined with retrograde intrarenal surgery / 中华泌尿外科杂志

Objective To evaluate the efficacy and advantages of the technique by combined PCNL and retrograde intrarenal surgery (RIRS) in a second stage to treat the complex renal stones in solitary kidney cases.Methods PCNL most with a single 18-24 F tract was performed first and RIRS was carried out at a second stage in solitary kidneys of 21 patients,of which congenital in 14.3％ (3 cases),contralateral nephrectomy in 42.8％ (9 cases),and functional solitry kidneys in 42.8％ (9 cases).Of the 21 patients,the average age was 45 years with 15 males and 6 females.The stones were 8 multiple,6 partial staghorn,and 7 complete staghorn with a mean size of 4.6 (3.8-6.8) cm.Results Of the 21 PCNL cases,a single tract,double,triple tracts were established in 18 (85.7％),2 (9.5％),1 (4.8％) cases,respectively.Mean operation time of PCNL was 95 (45-175) min.After 1 day of PCNL,all case had residual stones with a mean size of 1.9 (1.0-3.5) cm.Two case occurred fever after PCNL and one case presented bleeding resolved by selective renal artery embolization.The mean operation time of RIRS was 72 (35-95) min.Stone-free rate after RIRS was 85.7％ (18/21).The final stone free rate increased to 95.2％ (20/21) after one case received a second-look PCNL and two cases accepted ESWL.Two cases occurred fever and steinstrasses after RIRS resolved by rigid ureteroscopy.At the 3 months follow-up,renal function became stable,improved and worse in 71.4％ (n=15),23.8％ (n=5),and 4.8％ (n=l) of patients.Conclusions PCNL combined with RIRS could be an effective and safe option for complex stones in solitary kidneys with less bleeding,reduced tracts,minor complications and good renal function preservation.