Optimisation of Minimally Invasive Treatment Methods for Solitary Kidney Stones

Abstract

Nephrolithiasis is one of the most prevalent urological disorders worldwide, with a global recurrence rate of 50% within ten years and a particularly high prevalence in Central Asia reaching 18–22% of the adult population. In patients with a solitary functioning kidney, stone disease represents a critical clinical situation requiring precise, minimally invasive intervention to preserve renal function while achieving maximum stone clearance. This prospective comparative study aimed to optimize minimally invasive treatment protocols — specifically percutaneous nephrolithotomy (PCNL) and ureteroscopy with holmium laser lithotripsy (URS-LL) — in patients with solitary kidney urolithiasis, and to evaluate their comparative safety and efficacy profiles. Materials and Methods.  A total of 137 patients with solitary kidney stone disease were enrolled and allocated to two groups: PCNL group (n=72, stones 11–42 mm) and URS with holmium laser lithotripsy group (n=65, stones 6–20 mm). Diagnostic evaluation included renal ultrasound, multislice CT (stone density measurement in HU), urine culture, and complete blood count. Statistical analysis was performed using SPSS v.26 (IBM, USA); Student t-test, chi-squared test, and logistic regression were applied; p<0.05 was considered statistically significant. Results. Stone-free rate (SFR) at 3 months was 93.1% for PCNL and 87.7% for URS-LL (p=0.012). Mean operative time was significantly shorter in the URS group (51.8±17.4 vs 74.3±22.1 min, p<0.001). Hospital stay was 1.9±0.8 days for URS versus 3.8±1.2 days for PCNL (p<0.001). Overall complication rates were 13.9% (PCNL) and 7.7% (URS), predominantly Clavien grade I–II. 12-month recurrence rates were 11.1% (PCNL) and 15.4% (URS, p=0.426). Return to social activity was significantly faster in the URS group (5.2±2.1 vs 12.4±3.7 days, p<0.001). Conclusions. Both PCNL and URS with holmium laser lithotripsy demonstrate high efficacy and acceptable safety profiles in solitary kidney nephrolithiasis. Stone size and density are the primary determinants of technique selection. URS is preferred for stones ≤20 mm due to shorter hospitalization and faster recovery; PCNL remains the gold standard for stones >20 mm. Individualized treatment planning based on stone characteristics is essential for optimal outcomes in this high-risk patient population.