Surgical treatment of patients with large and staghorn stones of the solitary kidney: experience of the Scientific Institute of Urology

Katibov M.I., Merinov D.S., Gadzhiev G.D., Hnykin F.N., Shvangiradze I.A.

Introduction. Analysis of the – experience with large and staghorn stones of the solitary kidney was carried out to optimize the treatment of this group of patients.

Materials and methods. This study included 74 patients with large (>20 mm) and staghorn stones of solitary (functionally solitary) kidney. In 73 patients the following operations were performed: in 58 patients – percutaneous nephrolithotomy (PCNL), in 2 – retrograde intrarenal surgery (RIRS), in 2 – extracorporeal s hock-wave lithotripsy (ESWL), in 11 – open surgery. In 1 patient operation was cancelled due to respiratory disease.

Results. Following one PCNL procedure the success (stone-free state or residual fragments ≤3-5 mm) was achieved in 45 patients (77,6%), secondary procedures (ESWL, second PCNL and RIRS) increased this rate up to 96,6% (56 patients). Major complications after PCNL were reported in 2 cases: suppurative pyelonephritis with renal bleeding (necessitating the revision of kidney two times and decapsulation of kidney) and death (related to sepsis). In patients with open surgery a complete stone-free rate was achieved in all patients, in 2 patients postoperative complications were evident: bleeding (treated conservatively) and deterioration of chronic kidney disease. Long-term recurrence rate after PCNL and open surgery was 10,4% and 18,2%, correspondingly. Following PCNL an improvement in kidney function was significant, which was not a case after the open surgery. Statistical analysis of the ESWL and RIRS data was not carried out due to a small number of cases.

Conclusion. Due to high efficacy and safety of the PCNL it could be recommended as method of choice in this group of patients.

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