Retrograde intrarenal surgery for the treatment of renal stones in patients with a solitary kidney: Does access sheath matter?

摘要

Background:Treating renal stones in patients with a solitary functioning kidney is challenging. The present study was aimed to assess the competence and safety of retrograde intrarenal surgery (RIRS) for the treatment of renal stones in a solitary kidney.MethodsBetween August of 2017 and August of 2019, 25 ensuing patients with a solitary kidney and renal calculi and who were treated with RIRS were prospectively enlisted in the study. All patients were assessed by non-contrast computed tomography before surgery. Stone-free status was determined if there were no residual fragments. The final stone-free rates (SFRs) were assessed 3?months after the last treatment session by plain X-ray KUB and ultrasonography. Patient demographics, perioperative and postoperative outcomes were prospectively evaluated. Serum creatinine levels and glomerular filtration rate (GFR) pre-procedure and during follow-up were correlated.ResultsTwenty-five patients underwent 26 procedures. The mean patient age was 42.81?±?12.3 (range 22–67) years. The mean stone size was 18.23?±?6.27?mm (range 9–25?mm) and the mean operative time was 46.15?±?15.34?min (range 25–100?min). A ureteral access sheath (UAS) was used in five (19.2%) pre-stented patients. One patient (3.8%) required the second stage RIRS for residual stones. The SFR after the initial and final procedures, the SFR was 84% and 92%, respectively.The mean serum creatinine levels were significantly reduced post-surgery compared to preoperative levels (1.76?±?1.21?mg/dL; 1.37?±?0.60?mg/dL; p value 0.001) while GFR not encounter any significant variation post-surgery (63.04?±?33.16?ml/min) compared to preoperative rates (61.12?±?34.76?ml/min, p value 0.502). Minor complications classified as Clavien I or II developed in 5 patients (20%). Clavien IIIb, a major complication, developed in one (4%) patient, which was caused by steinstrasse and necessitated emergency surgical intervention.ConclusionRenal stones in a solitary kidney can be managed using RIRS safely and effectively with and without the use of UAS, without compromising renal function.