Navriya SC. et al., 2025: Safety, feasibility, and efficacy of surgical intervention for Urolithiasis in patients with chronic kidney disease: A systematic review.

Shiv C Navriya, Om K Yadav, Ankit Shettar, Mahendra Singh, Jaydeep Jain, Shashank Kumar, Deepak P Bhirud, Gautam R Choudhary, Arjun S Sandhu 
World J Nephrol. 2025 Sep 25;14(3):105288. doi: 10.5527/wjn.v14.i3.105288. FREE FULL TEXT

Abstract

Background: Urolithiasisposes challenges in patients with chronic kidney disease (CKD), necessitating careful consideration of surgical interventions due to potential complications.

Aim: To assess the safety, feasibility, and efficacy of surgical interventions for urolithiasis in CKD patients.

Methods: Systematic review adhering to PRISMA guidelines. Comprehensive searches of PubMed, Scopus, Cochrane Library, Web of Science, and Embase were conducted for studies published from January 2014 to June 2024. Studies involving adult patients (≥ 18 years) with CKD undergoing surgical interventions for urolithiasis, including randomized controlled trials, cohort studies, case-control studies, and observational studies. Studies involving pediatric patients, those not specifically addressing CKD patients, review articles, commentaries, and editorials. Despite an extensive search, only six studies met the strict inclusion criteria, reflecting the limited available data on this topic. This limitation has been acknowledged and discussed.

Results: A total of 6 studies met the inclusion criteria, encompassing a diverse range of surgical interventions such as percutaneous nephrolithotomy (PCNL), ureteroscopy (URS), and extracorporeal shock wave lithotripsy (ESWL). Perioperative and postoperative complications varied across studies, with bleeding, infection, and acute kidney injury being the most common. The risk of complications was higher in patients with advanced CKD. Technical success rates were generally high, but feasibility was influenced by patient-specific factors such as CKD stage and comorbidities. Modifications to standard surgical techniques were often necessary. Stone-free rates and recurrence rates varied, with PCNL generally achieving higher stone-free rates compared to URS and ESWL. Long-term outcomes on renal function were inconsistent, highlighting the need for individualized treatment plans.

Conclusion: Surgical interventions for urolithiasis in CKD patients are associated with significant risks but can be effective in achieving stone clearance and symptom relief. The safety, feasibility, and efficacy of these interventions depend on patient-specific factors, necessitating a tailored approach. Further high-quality studies are needed to develop standardized guidelines and improve clinical outcomes in this complex patient population.

Comment Hans-Göran Tiselius

Stone removal in patients with chronic kidney disease requires great care to make good rather than to make harm. Any kind of surgical trauma to a kidney with reduced renal function is associated with the risk of making the renal function worse.
The authors of this article addressed this difficult question by considering a systematic review of CKD-patients treated with PCNL, URS and SWL. The outcome and conclusions were based on results obtained in 142 reports. From these comparative studies the conclusion was that the outcome of stone removal was similar to that recorded in other comparisons between PCNL, URS and SWL.
The effects on renal function were at best described group-wise. In general, the effect on renal function is described only fragmental, but what is needed are detailed recommendations on how stone surgery should be carried out in a patient with specific CKD-problems.
I cannot but agree with the authors that it is necessary to refine treatment algorithms basically by minimizing the complications. Such conclusions, however, cannot be drawn from the systematic review presented in this report.

Hans-Göran Tiselius