Abstract
INTRODUCTION AND OBJECTIVES: The prevalence of nephrolithiasis is increasing worldwide. The purpose of this paper is to report our experience managing silent ureteral stones and to expose its’ true influence on renal function. METHODS: We prospectively analyzed 506 patients who underwent ureteroscopy for ureteral stone removal between January 2005 and May 2010. Silent ureteral stone definition: ureteral stone found in a patient without any specific or subjective ureteral stonerelated symptom. 27 (5,3% Global Cohort) patients met those criteria. All patients were assessed postoperatively with Dimercaptosuccinic Acid scintigraphy (DMSA). We considered abnormal a kidney relative function 45%. Pre and postoperative comparative DMSA analysis was electively obtained for 9 (34%) patients (Renal Function Cohort). We used the T-test for numerical variables and Chi-Square Test or Fisher’s Exact Test for categorical variables. Two-tailed values of P 0.05 were considered statistically significant. RESULTS: Demographic data is exposed on table 1. There were no statistically significant differences between Global Cohort and Renal Function Cohort. Primary therapy was ureteroscopic lithotripsy in 88%. Double J insertion was required in 90% and mean time to retrieval was 39 (7–100) days. Stone was considered impacted in 70%. Mean follow-up time was 23 (3–54) months. Overall ureteral stone-free rate after one and two procedures were 96% and 100%. Ureteral stenosis was seen in 2 patients during ureteroscopy and 2 after stone treatment. In the global Cohort, mean postoperative serum creatinine was not different from preoperative levels (p 0,39). Mean postoperative kidney relative function on DMSA was 31% (0–77%). In 17 (63%) patients, postoperative DMSA revealed impaired renal function. Hydronephrosis improvement was seen in 19 and stabilization in 7 patients, with one case showing worsening. In the Renal Function Cohort, all patients presented with impaired renal function preoperatively. There was no difference between pre and postoperative DMSA (22 12,1; vs. 20 11,8; p 0,83) and Cr (0,8 0,13; vs. 1,0 0,21; p 0,45). CONCLUSIONS: Silent ureteral stones are associated with decreased kidney function already at diagnosis. Although hydronephrosis tends to diminish after stone removal, renal function is likely to remain unaltered. Source of Funding: None
Published Version
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