The choice of urinary drainage in patients with ureteral calculi of solitary kidneys.
OBJECTIVE
To evaluate the safety and efficacy of the treatment of patients with ureteral calculi of solitary kidneys (UCSK) in relation to the modality of urinary drainage.


METHODS
We have studied a total of 55 patients with UCSK during the period from 1999 to 2002, 15 of them (27.3%) with radio-opaque calculi (ROC). The group included 13 female and 42 male patients, aged 36 to 62 years. In 24 (43.6%) patients the stone treated represented the first stone episode. The stones were mainly located in distal ureter (in 39 patients, 70.9%). Stone size was heterogeneous, with the majority of the patients (26 patients, 47.3%) having calculi no more than 5 mm wide. In 41 patients (74.5%) reasons for early intervention occurred such as urosepsis, persistent ureteral obstruction and acute pyelonephritis with anuria. The patients were divided in 2 groups of patients in accordance with the modality of urinary drainage: 30 (54.5%) patients with double-J stent (group A) and 25 (45.5%) with percutanous nephrostomy (group B). After carrying out conservative methods for stone passage in all patients, we performed extracorporeal lithotripsy (ESWL) (1-3 treatments) in 40 (72.7%) patients. After ineffective stone removal we used instrumental procedures, such as ureteroscopy (with electrohydraulic or ultrasonic lithotripsy).


RESULTS
The spontaneous passage rate of UCSK after conservative treatment and ESWL was obtained in 23 (76.7%) patients of the group A and in 21 (84.0%) patients of the group B. In 7 (23.3%) cases with ROC we observed acute back pain and anuria when the double-J stent was removed after ESWL. Ureteroscopy was performed in all such patients. Percutanous nephrostomy was placed in 5 patients with ROC before endoscopic manipulation. In 2 cases with ROC we performed ureteroscopy without previous nephrostomy but urosepsis and intractable pain occurred. Electrohydraulic endoscopic lithotripsy was performed in 4 (16.0%) cases of group B after ineffective ESWL. Ineffective result of ESWL could be explained by the sacro-iliac location of the stone in such cases.


CONCLUSIONS
Placement of percutaneous nephrostomy in patients with radio-opaque ureteral calculi in solitary kidney could give us a chance to make the lithotripsy easier. We showed the feasibility of endoscopic manipulation of the ureter in solitary kidneys preventing open surgical intervention.
State Pediatric Medical Academy, St. Petersburg, Russia.
Sergei
S
Gorelov
Faez
F
Zedan
Vladimir
V
Startsev
D004322:Drainage; D006801:Humans; D007668:Kidney / Q000002:abnormalities*; D009392:Nephrectomy; D014514:Ureteral Calculi / Q000150:complications / Q000628:therapy*