The choice of urinary drainage in patients with ureteral calculi of solitary kidneys.

Purpose: To evaluate the safety and efficacy of the treatment of patients with ureteral calculi of solitary kidneys (UCSK) in relation to the modality of urinary drainage.

Materials And Methods: We have studied a total of 55 patients with UCSK during the period from 1999 to 2002, 15 of them (27.3%) with radio-opaque calculi (ROC). The group included 13 female and 42 male patients, aged 36 to 62 years. In 24 (43.6%) patients the stone treated represented the first stone episode. The stones were mainly located in distal ureter (in 39 patients, 70.9%). Stone size was heterogeneous, with the majority of the patients (26 patients, 47.3%) having calculi no more than 5 mm wide. In 41 patients (74.5%) reasons for early intervention occurred such as urosepsis, persistent ureteral obstruction and acute pyelonephritis with anuria. The patients were divided in 2 groups of patients in accordance with the modality of urinary drainage: 30 (54.5%) patients with double-J stent (group A) and 25 (45.5%) with percutanous nephrostomy (group B). After carrying out conservative methods for stone passage in all patients, we performed extracorporeal lithotripsy (ESWL) (1-3 treatments) in 40 (72.7%) patients. After ineffective stone removal we used instrumental procedures, such as ureteroscopy (with electrohydraulic or ultrasonic lithotripsy).

Results: The spontaneous passage rate of UCSK after conservative treatment and ESWL was obtained in 23 (76.7%) patients of the group A and in 21 (84.0%) patients of the group B. In 7 (23.3%) cases with ROC we observed acute back pain and anuria when the double-J stent was removed after ESWL. Ureteroscopy was performed in all such patients. Percutanous nephrostomy was placed in 5 patients with ROC before endoscopic manipulation. In 2 cases with ROC we performed ureteroscopy without previous nephrostomy but urosepsis and intractable pain occurred. Electrohydraulic endoscopic lithotripsy was performed in 4 (16.0%) cases of group B after ineffective ESWL. Ineffective result of ESWL could be explained by the sacro-iliac location of the stone in such cases.

Conclusions: Placement of percutaneous nephrostomy in patients with radio-opaque ureteral calculi in solitary kidney could give us a chance to make the lithotripsy easier. We showed the feasibility of endoscopic manipulation of the ureter in solitary kidneys preventing open surgical intervention.