Minimally invasive approaches to the treatment of solitary kidney urolithiasis

Parshenkova I.G., Dutov V.V., Rumyancev A.A., Mamedov E.A.

Aim of the study: to evaluate the efficacy of the minimally invasive approaches to the treatment of solitary kidney urolithiasis (ESWL, PCNL, RIRS).

Materials and methods. Study group included 62 patients with ESWL, 49 patients with PCNL and 9 patients with RIRS. Efficacy control included the early post-operative stone related outcomes and the outcomes at 3 months of follow up

Results. ESWL efficacy was 85.5%. Outcome-related parameters were initial stone size (p< 0.0001) and upper tract urodynamics (p< 0.0001). Complication (32.2%) and additional manipulations (16.1%) rates were moderate, which stems from the pre-stenting of the kidney before the ESWL in patients with large (>13 mm) and multiple stones. PCNL efficacy was 93.9%. Stone free rate was not affected by stone size (p=0,594) and initial upper tract urodynamics (p=0.205). Complications were evident in 44.9% of cases, the necessity for secondary manipulations was rather low (26.5%).

Correlations with clinical form of the solitary kidney and complications of ESWL or PCNL were not present; the causation for contralateral kidney loss was also not relevant.

Efficacy of the RIRS was 77.8% with high complication rate of 66.6%. The group was relatively small, further evaluation is necessary.

Conclusions. ESWL, PCNL and RIRS are highly effective approaches to solitary kidney stones. Of outmost importance is the proper selection of patients for every treatment modality, preoperative preparation, operational technique and postoperative care.

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