OBJECTIVE - to evaluate if renal function loss and hydronephrosis due to a silent ureteral stone might be reversed.
METHODS - We prospectively selected patients with silent ureteral stones between Jan/06-Jan/14. A silent case was considered if there were no specific or subjective symptoms related to the ureteral stone.
Patient, stone and kidney characteristics were evaluated preoperatively, three and twelve months postoperatively. Renal function was accessed in the same intervals with serum creatinine (sCr), glomerular filtration rate (GFR) and (99m)Tc-DMSA. Patients without complete pre and postoperative evaluation were excluded. Primary end-point was mid-term progress of global and ipsilateral renal function. Secondary end-points included the evaluation of renal and collecting system anatomy from diagnosis to 12 months after treatment. ANOVA with repeated measures and marginal homogeneity test were used to evaluate renal function and hydronephrosis progression.
RESULTS - Twenty-six patients met our inclusion criteria. Mean preoperative SCr and GFR was 1.24mg/dL and 72.5ml/min, respectively. At initial scintigraphy, mean renal function was 33.4%. Laser ureterolithotripsy was performed in 84.6% of cases and all patients were rendered stone free. Two patients (8%) developed ureteral stenosis. There was no difference regarding SCr (p=0.89), GFR (p=0.48) and renal function at scintigraphy (p=0.19) during follow-up. Hydronephrosis significantly improved from pre to three months postoperatively (p<0.0001), but not from three to twelve months (p=0.065).
CONCLUSIONS - Patients with silent ureteral stones present with significant impairment of ipsilateral renal function and hydronephrosis at diagnosis. On mid-term follow-up evaluation, renal function of the affected unit remains stable while hydronephrosis improves after treatment.
Urology. 2016 Mar 08 [Epub ahead of print]
Giovanni S Marchini, Fábio Carvalho Vicentini, Manoj Monga, Fábio César Miranda Torricelli, Alexandre Danilovic, Artur Henrique Brito, Cesar Câmara, Miguel Srougi, Eduardo Mazzucchi
Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio. Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio., Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio., Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil., Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil., Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil., Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil., Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.