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Pietropaolo A. et al., 2019: Endourological management (PCNL, URS, SWL) of stones in solitary kidney - A systematic review from European Association of Urologists (EAU) Young Academic Urologists (YAU) and Uro-Technology (ESUT) groups

Pietropaolo A, Reeves T, Aboumarzouk O, Kallidonis P, Ozsoy M, Skolarikos A, Tailly T, Liatsikos E, Traxer O, Somani BK.
Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom.
Department of Urology, Queen Elizabeth University Hospital, Glasgow, United Kingdom.
Department of Urology, University of Patras, Patras, Greece.
Department of Urology, Medical University of Vienna, Vienna, Austria.
2nd Department of Urology, University of Athens, Sismanoglio Hospital, Athens, Greece.
Department of Urology, University Hospitals Ghent, Ghent, Belgium.
Tenon Hospital, Pierre and Marie Curie University, Paris, France.

Abstract

INTRODUCTION: Urolithiasis in solitary kidney(SK) presents significant management dilemma as any insult to the kidney or its drainage can lead to significant morbidity. The treatment options includes shock wave lithotripsy(SWL), percutaneous nephrolithotomy(PCNL) and ureteroscopy(URS). Our aim was to conduct a systematic review of literature on all available endourological techniques reporting on management of stones in a solitary kidney. MATERIAL AND METHODS: We conducted a systematic review according to Cochrane and PRISMA checklist for all English-language articles from inception to December 2018. All studies with a minimum of 10 patients that reported on endourological management(SWL, PCNL or URS) were included. Data was extracted for patient and stone demographics, outcomes including stone free rate (SFR), adverse events and renal function. RESULTS: After an initial search of 553 papers, 27 were included for the final review(10 PCNL, 1 mini-PCNL, 9 URS, 1 SWL and 6 comparative studies). The choice of treatment seemed to be based on stone size with PCNL, URS and SWL offered for mean stone sizes between 25-50mm, 10-28mm and 12-15mm respectively. PCNL, URS and SWL were reported in 1445, 792 and 186 patients respectively, with a final SFR of 67-97.7%, 43-100% and 73-80% and a complication rate of 26.4%, 15% and 16.7% across the three groups. The renal function deterioration was reported in 4/16 PCNL studies and 1/15 URS study, while it remained unaffected in the SWL study. CONCLUSION: Our review shows a rise of endourological techniques in the management of stones in solitary kidney. Although PCNL was used for larger stones, it had a higher risk of major complications including blood transfusion. While, good stone free rate was obtained for patients irrespective of the treatment modality, the selected intervention needs to be balanced with its safety profile and the need for ancillary procedures.
J Endourol. 2019 Sep 26. doi: 10.1089/end.2019.0455. [Epub ahead of print]

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Comments 1

Peter Alken on Thursday, 05 December 2019 08:15

“With no recommended guidelines on the management of stones in solitary kidney, our aim was to conduct a systematic review of literature on all available endourological techniques reporting on stones in a solitary kidney and to review and summarise the literature on surgical outcomes in these patients.”
In my opinion the care given to a solitary kidney should be identical to the one with a contralateral mate and there should be no difference in results and complications. The difference could be that both, physician and patient could be more nervous. This could lead to more patients with solitary kidneys being treated more frequently by experienced surgeons and better results. Unfortunately the authors did not examine if results or complications with single kidneys are different from those with bilateral kidneys.

“With no recommended guidelines on the management of stones in solitary kidney, our aim was to conduct a systematic review of literature on all available endourological techniques reporting on stones in a solitary kidney and to review and summarise the literature on surgical outcomes in these patients.” In my opinion the care given to a solitary kidney should be identical to the one with a contralateral mate and there should be no difference in results and complications. The difference could be that both, physician and patient could be more nervous. This could lead to more patients with solitary kidneys being treated more frequently by experienced surgeons and better results. Unfortunately the authors did not examine if results or complications with single kidneys are different from those with bilateral kidneys.
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