Flexible Ureteroscopy as the New Standard for the Management of Renal Transplant Urolithiasis <15 mm: A Single-Center Experience

Abstract

Objectives: To determine the safety and efficacy of flexible ureteroscopy in the treatment of transplant urolithiasis. Materials and Methods: We reviewed a single-center series of 2652 patients who underwent surgical treatment for nephrolithiasis at our institution from 2009 to the present day to identify all patients undergoing ureteroscopy for treatment of transplant lithiasis. Results: We identified 18 patients who underwent ureteroscopy for treatment of urolithiasis within the transplanted kidney or ureter. The majority of the procedures were performed using a retrograde approach with flexible ureteroscopy, with one patient undergoing antegrade ureteroscopy and two patients requiring semirigid ureteroscopy. Holmium:yttrium-aluminum-garnet laser lithotripsy was utilized in all but one case, which was performed using basket extraction. There were no intraoperative complications reported. Four patients had small stone fragments on postoperative imaging, three of which were observed. One patient required repeat ureteroscopy for persistent distal ureteral stone. Conclusion: Retrograde ureteroscopy is a feasible, safe, and effective intervention for the treatment of transplant lithiasis. Minimal intraoperative or postoperative complications were reported, and only one patient required additional intervention for residual stone burden.

Management of de novo nephrolithiasis after kidney transplantation: a comprehensive review from the European Renal Association CKD-MBD working group

“…As small stones (<4 mm) are likely to pass spontaneously, conservative management with close follow-up is usually the treatment of choice [ 76 ]. However, this approach demands meticulous clinical, radiologic and laboratory monitoring, therefore watchful waiting is not frequently utilized [ 77 ]. Since residual stones and recurrence of nephrolithiasis are frequently reported in the literature, choosing the most efficient intervention, and correcting the predisposing factors, including metabolic abnormalities, avoiding UTI, and using metaphylaxis for nephrolithiasis are essential [ 51 ].…”

“…Antegrade and retrograde ureteroscopy with a semi-rigid ureteroscope is the method of choice with low complication rates for stones located in the distal to mid-ureter, whereas RIRS using a flexible ureteroscope is the preferred option for proximal uretra and kidney stones [ 77 ]—additionally, it is preferred among pregnant or obese patients or patients with bleeding diathesis [ 97 ]. For smaller stones in the transplant kidney, an endoscopic approach is also favoured [ 98 ].…”

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

“…), у 18 из которых была проведена уретероскопия по поводу конкрементов трансплантированной почки или мочеточника; большинство процедур было выполнено с использованием ретроградного доступа. У 16 из 18 пациентов оказалось достаточно одной процедуры для полной элиминации конкремента [30].…”

Single use flexible ureteroscopes: Current status and future directions

“…This includes the introduction of digital technology, optic systems and a wide selection of accessories that can be used 4,5 . As such, the selection of patient groups that can be safely treated has been expanded and now includes patients at the extremes of age, pregnancy and complex anatomy such as renal transplants 6–8 . Single use (SU) flexible ureteroscopes (also referred to as ‘disposable’) are another development that became commercially available in October 2015 9 .…”

“… 4 , 5 As such, the selection of patient groups that can be safely treated has been expanded and now includes patients at the extremes of age, pregnancy and complex anatomy such as renal transplants. 6 , 7 , 8 Single use (SU) flexible ureteroscopes (also referred to as ‘disposable’) are another development that became commercially available in October 2015. 9 Their invention was largely borne out of attempts to eliminate maintenance requirements and the associated costs as well as durability issues such as deflection loss after multiple usages.…”