# Safety and Efficacy of Percutaneous Nephrolithotomy in Solitary Functioning Kidneys: A Retrospective Cohort Study in an Asian Population

## TL;DR

This study shows that percutaneous nephrolithotomy is a safe and effective treatment for kidney stones in patients with only one functioning kidney.

## Contribution

The study provides safety and efficacy data for PCNL in solitary functioning kidneys within an Asian population.

## Key findings

- PCNL achieved a 95.74% stone clearance rate in patients with a solitary functioning kidney.
- Mean serum creatinine levels improved postoperatively, indicating preserved renal function.
- Most patients required a single tract and had manageable complications, such as transfusion in 10.64% of cases.

## Abstract

Objective

The aim of the study was to assess the safety of preserved renal function after standard percutaneous nephrolithotomy (PCNL) in patients with a single functional kidney. The main parameters to focus on were serum creatinine levels and any associated complications.

Materials and methods

This retrospective cohort study was conducted in an Eastern population in a single center from 2016 through 2023 at The Kidney Centre Postgraduate Training Institute, Karachi, Pakistan.

Results

Out of the total 1,550 PCNL procedures performed on adult patients, 47 patients had a solitary functioning kidney with stones, which were evaluated. The stone clearance rate was 95.74% (45 patients), with a mean operative time of 85.96 minutes. Most patients, i.e., 33 (70.21%), had an infracostal approach, and single tract management was sufficient for 45 (95.74%) patients. The most common complication was transfusion, which was required in five (10.64%) patients. Mean preoperative hemoglobin dropped by 1.43mg/dL postoperatively, and mean serum creatinine decreased from 2.45mg/dL to 1.97mg/dL. Among the 24 (51.06%) analyzed stones, all were calcium oxalate.

Conclusion

In challenging situations such as a solitary kidney with a large stone, PCNL is the procedure of choice. However, the refined technique is of paramount importance. Overall, the use of PCNL in these unique conditions is safe and rewarding.