Modern approaches to treatment of large and staghorn stones of anatomical and functional solitary kidney

Operative treatment in patients with large and staghorn urinary stones of anatomically or functional solitary kidney is one of the complicated problems in urology. Literature review shows that extracorporeal shockwave lithotripsy (ESWL) as monotherapy has low efficacy in patients with this form of urolithiasis and its role could be described as amplification of other modalities, for example, in the combination treatment with transurethral and percutaneous manipulations. The application of retrograde intrarenal surgery (RIRS) in this situation seems to demonstrate non-inferiority when compared to percutaneous nephrolithotripsy (PCNL) with a significantly lower risk of high-grade complications. Laparoscopy also showed sufficiently high efficacy and safety in patients with solitary kidney nephrolithiasis, but it could not be used as first-line therapy in the operative treatment of these patients, staying as reserve in those cases, when PCNL and RIRS are not available. Open surgery use should be restricted given the substantial deterioration of the solitary kidney function. Among all the aforementioned techniques PCNL showed the best outcomes in terms of stone-free rate and function preservation. Based on this it could be considered as a “gold standard” of treatment for large and staghorn stones of the solitary kidney. Drawing a conclusion, this literature review showed the features of all operative treatment modalities, which are applicable in patients with large and staghorn stones of solitary kidney, making possible the estimation of the perioperative risks and appropriate method selection.