Functional and morphological recovery of solitary kidneys after drainage. Double J stent placement vs emergency ureteroscopy: which one is reasonable?

The purpose of the study was to evaluate the functional and morphological recovery of solitary kidneys following the relief of obstruction by two different approaches. Data of 65 adult patients with acute renal failure in obstructed solitary kidney were evaluated. Depending on the type of emergent decompression procedure while 34 patients were treated with a double J stent placement only 31 patients underwent ureteroscopic lithotripsy with double J stent placement. Following these procedures, in addition to the amount of excreted urine during the first 24 h, changes in the serum creatinine levels and the degree of hydronephrosis were noted and evaluated during the first week of follow-up after intervention. Evaluation of the urine output values during the first 24-h period revealed a statistically significant difference in favour of ureteroscopic lithotripsy. Serum creatinine levels in terms of the mean change in serum creatinine values and also percentage of the changes revealed no statistically significant change between two groups. Comparative evaluation of the change in the degree of hydronephrosis between baseline and post-procedural seventh day values revealed a statistically significant decrease in favour of ureteroscopic lithotripsy. Lastly, there was a statistically insignificant but meaningful difference with respect to the percent of change in the degree of hydronephrosis between two group of cases. Although temporary decompression of the obstructed solitary kidney by placing a double J stent may relieve the obstruction to a certain extent; emergent ureteroscopic lithotripsy could be applied as a reasonable alternative where adequate experience and technical availability are present.