Safety and efficacy of flexible ureteroscopy and holmium laser lithotripsy for the treatment of renal stones in patients with a solitary kidney

Abstract

Objective To investigate the safety and efficacy of flexible ureteroscopy and holmium laser lithotripsy for the treatment of renal stones in patients with a solitary kidney. Methods Between May 2014 and June 2016, Clinical records of 17 cases of stones in a solitary kidney who underwent flexible ureteroscopy and holmium laser lithotripsy were reviewed. 10 of these cases were male and the others female; mean age of these cases was 45.8 (32-67) years. 9 were on the left side while 8 were on the right. 6 cases were with functional solitary kidney (with the GFR of the contralateral kidney less than 10ml/min), while 11 others were with anatomical solitary kidney (6 due to tumor, 2 due to tuberculosis, 3 being congenital). All cases underwent BUS, KUB as well as CTU to confirm diagnosis before surgery, with 8 diagnosed with renal pelvis calculi, 5 were with upper or middle calyx calculi, and 4 were with subrenal calyx calculi. The mean±SD size of the stones was 1.2±0.3 cm. Clinical manifestations were asymptomatic in 10cases, backache in 5 cases and fever in 2 cases. All patients underwent exams of CBC, urinalysis, liver and kidney function, coagulation function, ECG, chest X-ray as well as cleaning midstream urine cultivation after admission. Results Mean±SD operation time among all cases was (74.2±23.6)min, the amount of bleeding during surgery was 5-15 (mean: 8) ml, duration of hospitalization was 3-12 (mean: 4.5) days, ureteral stents are kept for an average time of 4 weeks after surgery. 3 patients developed fever after operation, 1 developed urosepsis; all these patients recovered after active anti-infection treatment. No post-operative complications such as fever, renal colic, hematuresis, ureteral perforation, active bleeding as well as sepsis were found among the other patients. The preoperative and postoperative serum creatinine had statistical difference (P<0.05) .14 patients were proved to be stone-free by KUB or CTU. The stone-free rate after a single operation was 82.3% (14/17). Residual stone were found in the 3 patients , who subsequently underwent a second flexible ureteroscopy and holmium laser lithotripsy. The stone-free rate after a second operation was 94.1%. Conclusions Flexible ureteroscopy and holmium laser lithotripsy is a safe and effective method for the treatment of nephrolithiasis in patients with a solitary kidney with a lower procedure-related injury rate, smaller amount of bleeding, a lower complication rate and a shorter time required to recover after surgery. Key words: Kidney stone; Solitary kidney; Flexible ureteroscopy; Percutaneous nephrolithotomy; Extracorporeal shock wave lithotripsy