Staghorn calculi require surgical treatment but remain a challenge for surgeons, especially in solitary kidney patients. Percutaneous nephrolithotomy(PCNL) has been greatly facilitating the removal of complex stones. Generally, surgical trauma could result in short-term renal impairment, but the extent and risk factors are unknown. As we know, the contralateral healthy kidney compensates for the affected kidney function. Therefore, we focus on studying changes of renal function before and after PCNL in solitary kidney patients and further evaluate the risk factors of renal dysfunction. Between January 2015 and December 2020, 92 solitary kidney patients underwent PCNL.We found renal function was significantly impaired after the operation(pre-operation vs post-operation Scr:131.92 ± 47.20umol/L vs 148.12 ± 52.29umol/L, p<0.001; eGFR: 55.52 ± 20.42ml/(min∗1.73m 2) vs 48.64 ± 19.46ml/(min∗1.73m 2), p<0.001). The deterioration of renal function in patients with UTI was statistically serious. Meanwhile, Scr significantly increased in longer time to clean up the stones(TIME) group(Table 1). After logistics regression analysis, UTI and long TIME are considered as the risk factors for deterioration of renal function(p<0.005) (Fig. 1). Our study demonstrates the extent to which PCNL affects short-term renal function in the unilateral kidney(Scr:16.20 ± 20.40umol/L; eGFR: -6.87 ± 10.04 ml/(min∗1.73m 2).Firstly, control the combined disease before surgery. For example, early use of antibiotics to treat UTI. Additionally, it is important to reduce the operative time as much as possible while achieving a higher stone-free rate. In our perspective, the significance of complete preoperative preparation and efficient intraoperative procedures in solitary kidney patients with staghorn calculi should be emphasized to ensure minimal renal injury.
Asian journal of surgery. 2021 Oct 07 [Epub ahead of print]
Jianwei Cui, Jiahao Wang, Yunjin Bai, Jia Wang
Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China. Electronic address: ., Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China., Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China. Electronic address: .