Kalatharan V. et al., 2020: Efficacy and Safety of Surgical Kidney Stone Interventions in Autosomal Dominant Polycystic Kidney Disease: A Systematic Review
Kalatharan V, Jandoc R, Grewal G, Nash DM, Welk B, Sarma S, Pei Y, Garg AX.
Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.
ICES, London, ON, Canada.
Division of Nephrology, University Health Network and University of Toronto, ON, Canada.
Division of Nephrology, Department of Medicine, Western University, London, ON, Canada.
Background: Reduced kidney function and distorted kidney anatomy in patients with autosomal dominant polycystic kidney disease (ADPKD) may complicate stone interventions more compared with the general population.
Objectives: To review studies describing the safety and efficacy of the 3 main stone interventions in adults with ADPKD: shock wave lithotripsy (SWL), ureteroscopy, and percutaneous nephrolithotomy (PCNL).
Design: Systematic review.
Setting: Any country of origin.
Patients: Adults with ADPKD who underwent SWL, ureteroscopy, or PCNL.
Measurements: Being stone free after the intervention and postoperative complications as reported by each study, which included pain, bleeding, and fever.
Methods: Relevant studies published until February 2019 were identified through a comprehensive search of MEDLINE, EMBASE, Web of Science, BIOSIS PREVIEW, and CINAHL. Studies were eligible for review if they reported at least one outcome following SWL, ureteroscopy, and/or PCNL in adults with ADPKD. We then abstracted information on study characteristics, patient characteristics, intervention details, and postintervention outcomes and assessed the methodological quality of each study using a modified Downs and Black checklist.
Results: We screened 221 citations from which we identified 24 studies that met our review criteria. We identified an additional article when manually reviewing the reference list of an included article, yielding a total of 25 studies describing 311 patients (32 SWL, 42 ureteroscopy, and 237 PCNL). The percentage of patients who were stone free after 1 session ranged from 0% to 69% after SWL, 73% to 100% after ureteroscopy, and 45% to 100% after PCNL. The percentage of patients with ADPKD that experienced at least one postoperative complication ranged from 0% to 33% for SWL, 0% to 27% for ureteroscopy, and 0% to 100% for PCNL.
Limitations: The number and quality of studies published to date are limited.
Conclusions: The efficacy and safety of stone interventions in patients with ADPKD remains uncertain, with wide-ranging estimates reported in the literature.
Can J Kidney Health Dis. 2020 Jul 22;7:2054358120940433. doi: 10.1177/2054358120940433. eCollection 2020. PMID: 32754344 Review. FREE ARTICLE
Even if all available data are collected, assembled and compared, it can be impossible to come to a proper conclusion. “Of the 25 included articles, 24 studies were case series (96%), and 1 (4%) was a cohort study. Sixteen (64%) of these were full-text journal articles, and 9(36%) were conference proceedings.”
It was probably not expected to conclude on the best treatment. The authors quote the AUA guideline (1): “The success rate of all 3 interventions is dependent on gaining optimal access to stones” and assuring fragment removal and /or passage, may be added.
However, the AUA guideline cannot serve as a guide as none of the 15 index patients classified in the AUA guideline on the management of stone patients is a patient with ADPKD
1. Assimos D, et al. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART I. J Urol. 2016 Oct;196(4):1153-60. doi: 10.1016/j.juro.2016.05.090.