Percutaneous nephrolithotomy in patients with solitary kidney: a critical outcome analysis

Int Braz J Urol. May-Jun 2015;41(3):496-502. doi: 10.1590/S1677-5538.IBJU.2014.0343.

Abstract

Purpose: To describe our experience with percutaneous nephrolithotomy (PCNL) in patients with solitary kidneys and analyze factors that can impact on intra-operative bleeding and postoperative complications.

Materials and methods: We reviewed our stone database searching for patients with solitary kidney who underwent PCNL from Jan-05 through Oct-13. Demographic data, stone characteristics, and intra- and postoperative outcomes were recorded. Spearman correlation was performed to assess which variables could impact on bleeding and surgical complications. Linear and logistic regressions were also performed.

Results: Twenty-seven patients were enrolled in this study. The mean age and BMI were 45.6 years and 28.8Kg/m(2), respectively; 45% of cases were classified as Guys 3 (partial staghorn or multiple stones) or 4 (complete staghorn) - complex cases. Stone-free rate was 67%. Eight (29.6%) patients had postoperative complications (five of them were Clavien 2 and three were Clavien 3). On univariate analysis only number of tracts was associated with increased bleeding (p=0.033) and only operative time was associated with a higher complication rate (p=0.044). Linear regression confirmed number of access tracts as significantly related to bleeding (6.3, 95%CI 2.2-10.4; p=0.005), whereas logistic regression showed no correlation between variables in study and complications.

Conclusions: PCNL in solitary kidneys provides a good stone-free rate with a low rate of significant complications. Multiple access tracts are associated with increased bleeding.

MeSH terms

  • Adult
  • Blood Loss, Surgical*
  • Body Mass Index
  • Female
  • Hematocrit
  • Humans
  • Kidney / abnormalities*
  • Kidney / surgery
  • Length of Stay
  • Logistic Models
  • Male
  • Middle Aged
  • Nephrolithiasis / surgery*
  • Nephrostomy, Percutaneous / adverse effects
  • Nephrostomy, Percutaneous / methods*
  • Operative Time
  • Postoperative Complications / etiology*
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Factors
  • Statistics, Nonparametric
  • Treatment Outcome