Abstract
Nephrectomy related to kidney stone disease, or “calculous nephrectomy,” is a procedure of last resort for surgical stone management. Bodempudi et al. report on contemporary trends in utilization and outcomes of calculous nephrectomy in the United States. A few findings are worth noting.
First, these procedures are uncommon (<1%), and the proportion of calculous nephrectomies to all inpatient procedures decreased from 0.71% in 2001 to 0.59% in 2014. This trend is likely because of the greater prevalence of CT imaging over this period for the general population, leading to earlier detection and intervention for stone disease, and improvements in minimally invasive techniques across urologic and interventional radiology disciplines to preserve renal function.
Second, calculous nephrectomy is morbid. The complication rate of this “benign” urologic procedure was 38% overall, with transfusion required in 16%. The renal unit undergoing calculous nephrectomy is no stranger to recurrent urinary tract infections, chronic obstruction, drains or stents, and often urinomas. Often an initial minimally invasive approach converts to an open incision because of the severe perinephric inflammation and fibrosis with absent tissue planes.
Finally, there are treatment disparities with calculous nephrectomy. This should not be surprising, since access to care equates to timely diagnosis and intervention to prevent the development of poorly functioning or nonsalvageable kidneys. There was also regional variation in treatment outcomes with calculous nephrectomy. The authors attribute some, but not all, of the trends to high versus low regional case volume. These findings deserve further study, but to do this would be difficult because of the given relatively low frequency of these procedures. With continued developments and innovations in kidney stone surgical management and medical preventative therapies, hopefully the need for calculous nephrectomy will continue to decline over time.