Endourological renal salvage in patients with calculus nephropathy and advanced uraemia

Objective To document our experience with percutaneous nephrolithotripsy (P CNL) for the treatment of calculus nephropathy and advanced renal failure. Patients and methods Between October 1989 and April 1996, 78 patients with calculus nephropathy (51 males and 27 females, mean age 42 years, range 16- 67; mean serum creatinine level 663.8 mu mol/L, range 282.8-1449.7) were tr eated in our department. Forty-six of the patients had bilateral upper urin ary calculi, while the remaining 32 had a solitary functioning kidney obstr ucted by stone. Thirty-two patients had a normal urine output, 26 were olig uric and 20 presented with anuria. A preliminary percutaneous nephrostomy ( PCN) was performed under local anaesthesia in 64 patients, and stone retrie ved subsequently through the same nephrostomy track after improvement in th eir uraemic status. In the remaining 14 patients, the stones were removed a t the first session. Of the 46 patients with bilateral stones, 21 underwent stone retrieval by PCNL on the contralateral side after an interval of 2-3 weeks, while 25 patients underwent simultaneous TT stenting on the contral ateral side, followed, after improvement in uraemic status, by delayed PCNL or extracorporeal shock wave lithotripsy on that side. Results There were three deaths, caused by overwhelming sepsis; 64 of the r emaining 75 patients recovered well from uraemia, while II showed no improv ement, suggesting irreversible renal damage. Complications included five pa tients with nonfatal sepsis and five with secondary haemorrhage. At the las t follow-up 2.5-9 years after presentation, the mean serum creatinine lever (271.3 mu mol/L) was significantly better than the mean preoperative level . Six patients are on maintenance haemodialysis. Conclusions It is not uncommon in developing countries for patients with ur olithiasis to present with advanced uraemia caused by long-standing obstruc tion, almost invariably complicated by infection. A percutaneous endourolog ical approach offers the best hope for these patients, and in our experienc e a significant percentage of these cases can be salvaged.