During our search we identified 28 studies for inclusion. PCNL was assessed in 21 studies including 1994 patients, URS in four studies including 608 patients, and four studies comparing PCNL and URS including 262 patients.
For patients undergoing PCNL, the majority of studies showed either improvement or trend to improvement in postoperative renal function. Only one study showed postoperative worsening and they measured renal function only on day 1 after PCNL. In three studies, the number of punctures was shown to predict deterioration and this supports the idea that the parenchymal damage required causes a decline in function. Patient comorbidities including hypertension, diabetes, and pre-existing poor function were identified as potentially important factors in predicting deteriorating renal function. This suggests that deterioration in renal function is determined by alternative underlying pathological processes.
Following URS, the overall trend was that renal function improved postoperatively and interestingly, a study found no association between multiple procedures and poor postoperative renal function. As with PCNL, one study showed that if preoperative renal function was abnormal then it had a tendency to deteriorate, but if it was normal preoperatively it remained normal postoperatively.
Our review suggests that endourological interventions do not adversely affect renal function and tend to improve it in patients who do not have a poor renal function prior to the procedure. Several factors including poor preoperative renal function, diabetes, hypertension, and multiple percutaneous tracts appear to predispose patients to declining renal function after procedure. These patients should be counseled for and followed up appropriately.
Written by: Bhaskar Somani, MRCS, FEBU, DM, FFSTEd, FRCS (Urol), and Thomas Reeves, MD, Professors of Urology, University Hospital Southampton NHS Foundation Trust, Southhampton, UK
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