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. 2025 Nov 10;43(1):679.
doi: 10.1007/s00345-025-06065-7.

Evolution of renal function after ureteroscopy in solitary kidney

Charles Jaouen  1   2   3   4 , Olivier Traxer  1   2   4   5   6 , Stefano Moretto  1   2   4   5   7 , Federico Zorzi  1   2   4   8 , Alberto Quarà  1   2   4   5   9 , Alejandra Bravo-Balado  1   2   4   5 , Letizia Maria Ippolita Jannello  1   2   4   10   11 , Luigi Candela  1   2   4 , Mariela Corrales  1   2   4 , Marie Chicaud  1   2   12 , Stessy Kutchukian  1   2   13 , Bastien Landreat  1   2   4 , Zine-Eddine Khene  14 , Thibaut Culty  3 , Souhil Lebdai  3 , Daron Smith  6   15 , Steeve Doizi  1   2   4   5   6 , Pierre Bigot  3   16 , Frédéric Panthier  17   18   19   20   21
Affiliations

Evolution of renal function after ureteroscopy in solitary kidney

Charles Jaouen et al. World J Urol. .

Abstract

Purpose: Flexible Ureteroscopy (FURS) in patients with a solitary kidney (SK) has been sparsely studied, especially its safety. Available literature suggests that the renal function remains stable after FURS with low evidence. We aimed to assess and predict the postoperative renal function after FURS in patients with SK, using Machine Learning (ML) models.

Methods: A dualcenter retrospective study was conducted between 2013 and 2023, including patients undergoing FURS in solitary kidneys. Demographic, peri-operative data, pre- and postoperative serum creatinine and estimated Glomerular Filtration Rate(eGFR) were collected. Multivariate analysis intended to identify risk factors for renal function decline. After data splitting, 12 ML models were trained and tested to predict the 3 months postoperative serum creatinine.

Results: A total of 87 patients were included. 84% were treated for urinary stones, 11% for upper tract urothelial carcinoma(UTUC), and 4% for ureteral stricture. With a mean follow-up of 32 months, the serum creatinine remained stable at 3-month and long-term follow-ups (- 0.4 mmol/L, p = 0.77 and - 2 mmol/L, p = 0.57), despite a transient early elevation (+ 14.4 mmol/L, p = 0.00069). Multiple linear regression identified six significant predictors of postoperative renal function modification: enterocystoplasty, renal agenesis, Candida albicans in preoperative urine culture, elevated preoperative serum creatinine, and preoperative JJ stent for renal colic or obstructive pyelonephritis. After training, the "Stacking" Ensemble model presented the lowest mean absolute error between pre- and postoperative(3months) serum creatinine (4% vs 17% without ML) in the test group.

Conclusion: FURS seems safe in patients with SK, with transient renal function effects. Accurate predictive models could improve patient management, helping to prevent renal impairment, with better patient selection.

Keywords: Acute kidney injury; Predictive model; Renal function; Solitary kidney; Ureteroscopy.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Research involving human participants or animals: This article does not contain any studies with human participants or animals performed by any of the authors.

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