Outcomes of percutaneous nephrolithotomy in patients with solitary kidneys: a single-center experience.

Objectives: To evaluate the outcomes, complications, and early and late postoperative kidney function of percutaneous nephrolithotomy (PCNL) in patients with solitary kidneys.

Methods: Between 2002 and 2009, 47 patients with a solitary kidney (congenital in 10 patients, 21.3%; contralateral nephrectomy in 22 patients, 46.8%; and nonfunctional kidney in 15 patients, 31.9%) underwent PCNL. Serum creatinine was measured preoperatively, on postoperative day 1, and at each follow-up visit at regular intervals. The 4-variable modification of diet in renal disease equation was used to calculate the estimated glomerular filtration rate (eGFR). The 5-stage classification of chronic kidney disease (CKD) was used according to the National Kidney Foundation published guidelines. Of 47 patients, 44 were followed least 6 months, whereas 3 patients were lost to follow-up.

Results: Success was achieved in 84.5% (40/47) of patients after 1 session of PCNL. Complex stones were detected in 32 (68.1%) patients. Among all patients, 23.4% (n = 11) of them required multiple accesses. Complications developed in 5 (10.6%) patients. At a mean follow-up time of 18.7 ± 11.8 (6-60) months, the overall success rate improved to 97.7% after auxiliary treatments. eGFR was 76.4 ± 27.1, 73.4 ± 26.1, and 83.5 ± 29.4 per 1.73 m(2) during preoperative period, immediate postoperative period, and at the last follow-up visit (>6 months), respectively (P < .001). According to CKD classification, kidney function was stable, improved and worse in 63.6% (n = 28), 29.5% (n = 13), and 6.8% (n = 3) of patients, respectively, compared with preoperative levels.

Conclusions: PCNL is safe and has an acceptably low complication rate in patients with solitary kidneys. At long-term follow-up, renal function had stabilized or improved in more than 90% of patients with a solitary kidney after PCNL.