The feasibility of one-stage flexible ureteroscopy lithotripsy in solitary kidney patients with 1-3 cm renal stones and risk factors of renal function changes

• Published in: Renal failure Vol. 43; no. 1; pp. 264 - 272
• Main Authors: Pan, Yang, Chen, Han, Chen, Hualin, Jin, Xiaoxiang, Zhu, Yunxiao, Chen, Gang
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01.01.2021; Taylor & Francis Ltd; Taylor & Francis Group
• Subjects: Adult; Aged; Aged, 80 and over; Calculi; Clinical Study; Computed tomography; Creatinine; Epidermal growth factor receptors; Feasibility Studies; Female; Flexible ureteroscopy lithotripsy; Glomerular filtration rate; Glomerular Filtration Rate - physiology; Hospitals; Humans; Kidney Calculi - complications; Kidney Calculi - therapy; Kidneys; Lithotripsy; Lithotripsy - adverse effects; Lithotripsy - instrumentation; Lithotripsy - methods; Male; Middle Aged; Nephrolithiasis; Operative Time; Patients; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - physiopathology; prior stenting; Renal function; renal stones; Retrospective Studies; Risk Factors; solitary kidney; Solitary Kidney - complications; Solitary Kidney - physiopathology; Stents - adverse effects; Tomography; Treatment Outcome; ureteral stent; Ureteroscopes - adverse effects; Ureteroscopy - adverse effects; Ureteroscopy - instrumentation; Ureteroscopy - methods; Urine; Urology; solitary kidney; glomerular filtration rate; renal stones; Flexible ureteroscopy lithotripsy; ureteral stent; prior stenting
• ISSN: 0886-022X; 1525-6049
• DOI: 10.1080/0886022X.2021.1872625

To compare perioperative outcomes and long-term renal function changes between prior stenting (PS) and not prior stenting (NPS) before flexible ureteroscopy lithotripsy (f-URS) for solitary kidney patients. Solitary kidney patients with 10-30 mm renal stones were enrolled in this historical control study. Perioperative parameters and complications were compared. Stone-free was defined as the absence of any residual stones on a CT scan. Renal function changes were evaluated by estimated glomerular filtration rate (eGFR) and adjusted for body surface area. A decrease in the eGFR over 20% was identified as 'deterioration' in renal function. The follow-up period was at least 6 months. Logistic regression was used to identify risk factors of renal function deterioration. Of the 76 patients included, 40 cases experienced prior stenting before f-URS. The average stone diameter was 16.8 ± 4.7 mm, ranging from 10.0 to 28.4 mm. Initial SFR was 85.0 and 83.3% in the PS and NPS groups, respectively (p = 0.842), while SFR after the second procedure was 97.5 and 94.4% (p = 0.926). Seven PS and 5 NPS patients developed complications (p = 0.666). At the postoperative 6 months, seven patients showed a deteriorated renal function. Surgical time in minutes was identified as a risk factor for renal function deterioration after the operation (OR = 1.061, 95% CI: 1.015-1.109, p = 0.009, per minute). It appears that one-stage f-URS without PS could be feasible for 10-30 mm renal stones in solitary kidney patients, and less surgical time might be beneficial to protect renal function.