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The functional effects of nephrolithotomy performed with ischaemia and cooling have been studied in a series of 29 operations performed on patients with a solitary kidney. There was temporary post-operative functional deterioration in every patient, but this was followed by rapid and satisfactory recovery, often with functional improvement, in 27 out of the 29 cases. Only 2 patients showed minor functional deterioration, but both benefited clinically from their surgery and remain well. No patient required permanent dialysis support. A previous study by Wickham (1979) has shown satisfactory results from 250 cases of nephrolithotomy performed with ischaemia and cooling, but in these cases it was not possible to assess the degree of compensation provided by the non-operated kidney. The study of patients undergoing surgery to solitary kidneys obviates the question of contralateral functional compensation.