The treatment choice of solitary kidney complicated with complex calculi report of 42 cases

Abstract

To investigate the therapeutics of complex calculi in solitary kidney, and to improve the effect and safety of treatment. Experiences in the treatment of 42 patients were summarized. All patients were with mould or multiple calculi, 8 cases were complicated with ureter calculi, and 6 cases were hospitalized because of obstructive anuria. The patients with mould calculi received extracorporal shock wave lithotripsy (ESWL) prior to percutaneous nephrolithotomy (PCNL). While the patients with multiple calculi received PCNL prior to ESWL. Some cases were treated by lithotripsy. Thirty-six cases (86%) were cured by ESWL combined with PCNL. Eleven cases received lithotripsy during PCNL. The 6 cases with obstructive anuria recovered in 12 hours after emergent ESWL or lithotripsy; 6 cases (14%) underwent open operation because of deformity or obstruction in renal pelvis and ureter; 2 cases have to keep nephrostomy because of repeated infection. Followed up 6-18 months, 38 cases (86%) keep good kidney function; 5 cases (14%) had renal insufficiency; 4 cases (11%) reoccurred calculi. The therapeutics of ESWL combined with PCNL may clear complex calculi of solitary kidney effectively and safe. It is necessary to take emergent ESWL in renal obstructive calculi cases. And the patients with lower ureter obstructive calculi may take lithotripsy first. It is proper to choose open operation on the patients with deformity of renal pelvis or obstruction of ureter.