The role and long-term follow-up of ureteroscopy and stone treatment(URSL) in patients with chronic kidney disease(CKD) is unclear. Given conflicting results and a lack of robust data, we looked at the results of URSL in patients with CKD.
Over a 6.5-year period(March 2012- July 2018), prospective outcomes were recorded for consecutive patients who underwent URSL for ureteric or renal stones. The inclusion criteria were all patients with CKD II-V. Renal function was checked pre-operatively and at a minimum of 6 months post-procedure. Data was collected and analysed for patient and stone demographics, procedural and post-operative details, and complications.
Over the study period, 277 patients with pre-operative CKD stage II-V were included with a male:female ratio of 188:89 and a mean age of 66.6 years. The mean pre-operative eGFR(mL/min) was 63(range:14-89;18) with 167(60.2%) CKD II, 70(25.2%) CKD IIIa, 27(9.7%) CKD IIIb, 10(3.6%) CKD IV and 3(1%) CKD V patients. The mean single stone size was 9.6 mm(range:3-37mm;5.2) and 35.3% had multiple stones. The stone was located in the ureter for 112 patients, kidney for 137 patients, with 28 patients who had stones in both ureter and kidneys. A pre- and postoperative stent was present in 34.3-60% and 82.6%-100% of patients respectively, with an access sheath used in 103(37.8%). The mean operative time was 44.5 minutes, with a stone free rate of 91.6%. Post-operatively the mean eGFR improved to 68(±20) (P<0.002). Complications occurred in 22(7.9%) patients of which 18 were Clavien I/II and 4 were Clavien III/IV complications.
URSL is safe and effective in patients with CKD with most patients discharged the same day of surgery. For majority of patients with both ureteric and renal stones, the renal function either stayed stable or improved after ureteroscopy on a long-term follow-up irrespective of their underlying CKD status.
Journal of endourology. 2019 Dec 31 [Epub ahead of print]
Thomas Reeves, Amelia Pietropaolo, Bhaskar K Somani
University Hospital Southampton NHS Foundation Trust, 7425, Southampton, Southampton , United Kingdom of Great Britain and Northern Ireland; ., University Hospital Southampton NHS Foundation Trust, 7425, Southampton, Southampton , United Kingdom of Great Britain and Northern Ireland; ., University Hospital Southampton NHS Foundation Trust, 7425, Southampton, Southampton , United Kingdom of Great Britain and Northern Ireland; .