Case Report: Mini-endoscopic combined intrarenal surgery in an en-bloc kidney transplant

Abstract

Background Overall incidence of stones in kidney transplant recipients is 1%. En-bloc kidney transplant is a rare anatomical condition in which kidney stones treatment can be extremely difficult to treat. As far as we know, no cases of staghorn calculi in en-bloc kidney transplant have been published so far. Case presentation A 27-year-old woman presented to the Emergency Department because of asthenia, adynamia and weight loss associated with lower urinary tract symptoms and subfebrile temperature. Ten years before, she had undergone an en-bloc kidney transplant because of end-stage renal disease secondary to perinatal asphyxia syndrome. One kidney was implanted capo-volta in the right iliac fossa and the other one in the right flank. NCCT scan showed incomplete staghorn calculi in the iliac fossa transplanted kidney. Besides, severe dilation of the native and the right flank transplanted kidney, due to two ureteral stones of 6 and 7 mm impacted in the uretero-ureteral anastomosis, was found. After hospital admission and under ceftriaxone prophylaxis, an attempt to perform primary RIRS following our COVID protocol was carried out. Nevertheless, we ended up placing a JJ stent because once the guidewire passed through the ureteral stones, purulent material came out from the ureteral orifice. She stayed 9 days in-hospital for management of postobstructive polyuria and was discharged with oral antibiotics. Three weeks afterward, we removed the stent and performed flexible ureteroscopy and holmium laser lithotripsy of the ureteral stones. In the same procedure, we performed Mini-ECIRS (21 French) previous ultrasound-guided upper pole puncture. Postoperative NCCT scan showed neither residual fragments nor operative complications. Conclusion This is the first clinical case reporting Mini-ECIRS in a patient with an en-bloc kidney transplant. This endourological approach seems to be a feasible, safe and effective approach to treat stones in this anatomically challenging condition.

Endoscopic combined intrarenal surgery for renal allograft lithiasis using “sheath-connection technique”: A case report

“…However, for RAL treatment, retrograde approaches using a UAS are often difficult or infeasible because of the ectopic location of the kidney allograft or ureterovesical implantation. 2 To the best of our knowledge, we did not find any similar reports of our reported procedure on normal kidneys. For this reason, there are few cases in which UAS insertion is difficult when the ureter is in a normal position.…”

“…For RAL treatment, retrograde approaches using a ureteral access sheath (UAS) are often difficult or infeasible because of the ectopic location of the kidney allograft or ureterovesical implantation. 2 …”

Efficacy of extracorporeal shock wave lithotripsy for post-transplant kidney stones. Hope or Disappointment?

“…Данные метаанализа W. Cheungpasitporn et al свидетельствуют о том, что в подавляющем большинстве случаев основой камней являются соли кальция (оксалат и фосфат) [6,7]. Частота встречаемости уратов находится в пределах 0,2-10% [8].…”

“…Пациенты с почечным трансплантатом и нефролитиазом нуждаются в повышенном внимании ввиду изменения у них функции почек и почечной иннервации. Выжидательная консервативная тактика ведения пациентов, у которых размеры конкрементов в трансплантате не превышают 4-6 мм, предполагает строгое клиническое, рентгенологическое и лабораторное наблюдение [7][8][9] Nephrolithiasis in a transplanted kidney is an important medical and social problem. The presence of renal calculi may not manifest clinically for a long time due to the peculiarities of the surgical intervention during organ transplantation.…”