title: Outcomes of percutaneous nephrolithotomy in patients with solitary kidneys: a single-center experience.
abstract: OBJECTIVE
  To evaluate the outcomes, complications, and early and late postoperative kidney function of percutaneous nephrolithotomy (PCNL) in patients with solitary kidneys.
  
  
  METHODS
  Between 2002 and 2009, 47 patients with a solitary kidney (congenital in 10 patients, 21.3%; contralateral nephrectomy in 22 patients, 46.8%; and nonfunctional kidney in 15 patients, 31.9%) underwent PCNL. Serum creatinine was measured preoperatively, on postoperative day 1, and at each follow-up visit at regular intervals. The 4-variable modification of diet in renal disease equation was used to calculate the estimated glomerular filtration rate (eGFR). The 5-stage classification of chronic kidney disease (CKD) was used according to the National Kidney Foundation published guidelines. Of 47 patients, 44 were followed least 6 months, whereas 3 patients were lost to follow-up.
  
  
  RESULTS
  Success was achieved in 84.5% (40/47) of patients after 1 session of PCNL. Complex stones were detected in 32 (68.1%) patients. Among all patients, 23.4% (n = 11) of them required multiple accesses. Complications developed in 5 (10.6%) patients. At a mean follow-up time of 18.7 ± 11.8 (6-60) months, the overall success rate improved to 97.7% after auxiliary treatments. eGFR was 76.4 ± 27.1, 73.4 ± 26.1, and 83.5 ± 29.4 per 1.73 m(2) during preoperative period, immediate postoperative period, and at the last follow-up visit (>6 months), respectively (P < .001). According to CKD classification, kidney function was stable, improved and worse in 63.6% (n = 28), 29.5% (n = 13), and 6.8% (n = 3) of patients, respectively, compared with preoperative levels.
  
  
  CONCLUSIONS
  PCNL is safe and has an acceptably low complication rate in patients with solitary kidneys. At long-term follow-up, renal function had stabilized or improved in more than 90% of patients with a solitary kidney after PCNL.
authors.affiliation: Haseki Training and Research Hospital, Department of Urology, Istanbul, Turkey. takman36@gmail.com
authors.forename: Tolga
authors.initials: T
authors.lastname: Akman
authors.forename: Murat
authors.initials: M
authors.lastname: Binbay
authors.forename: Erdem
authors.initials: E
authors.lastname: Tekinarslan
authors.forename: Unsal
authors.initials: U
authors.lastname: Ozkuvanci
authors.forename: Cem
authors.initials: C
authors.lastname: Kezer
authors.forename: Akif
authors.initials: A
authors.lastname: Erbin
authors.forename: Yalcin
authors.initials: Y
authors.lastname: Berberoglu
authors.forename: Ahmet
authors.initials: A
authors.lastname: Yaser-Muslumanoglu
mesh_terms: D000328:Adult; D006801:Humans; D007668:Kidney / Q000002:abnormalities / Q000502:physiology; D007669:Kidney Calculi / Q000150:complications / Q000601:surgery*; D008875:Middle Aged; D009392:Nephrectomy; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome