Mini-Percutaneous Nephrolithotomy with Ureteral Access Sheath in a Transplanted Kidney: Case Report and Literature Review

Abstract

This is the case of a 69-year-old woman with a history of right iliac fossa living-related kidney transplant that developed acute renal failure due to an obstructing stone in the proximal transplant ureter. She was successfully treated with mini-percutaneous nephrolithotomy wherein a 14-Fr tract was created with serial dilation and a 14-Fr ureteral access sheath was used for access. A flexible ureteroscope with holmium laser and a helical wire basket were used to fragment and extract the stone, respectively. A 10-Fr nephrostomy tube was left for postoperative drainage. There are only a few published reports of mini-percutaneous nephrolithotomy in transplant kidneys, but those reports suggest that the procedure is safe and effective.

Mini-percutaneous nephrolithotomy via ultrasound guidance in transplanted kidney: a report of two cases

“…in North America over ten years, a case report by Munk et al . and a case reported by Kadlec and colleagues [ 1 , 2 , 4 , 11 ]. A new study explains five antegrade ureteroscopic surgeries done on patients with kidneys transplantation; however, no tract dilation was conducted, and the stone size was about 15 mm [ 5 ].…”

“…However, several patients may require more than one technique for stone clearance [ 1 ]. The procedure for stones in the transplanted kidney may be particularly challenging due to the patient's immunodeficient state and the kidney's extra-anatomical position [ 2 ]. The first mention of the PCNL procedure in a transplanted kidney was made in 1985 [ 3 ].…”

“…The PCNL procedures in transplanted kidneys are associated with potential graft loss and significant bleeding risk. For that, surgeons believe that these procedures must be restricted to significantly bigger stone burdens and performed only by an experienced urologist and at professional centers [ 2 ].…”

“…Minimally invasive PCNL (mini-PCNL) is a nominally invasive procedure that uses a small access sheath for puncturing the kidney (Fr 12 to 20). The technique may be accompanied by a minor risk of bleeding and other postoperative complications [ 2 , 7 ]. Here, we report our experience of the mini-PCNL procedure with US guidance in the two cases of urolithiasis in transplanted kidney patients.…”

Treatment of recurrent renal transplant lithiasis: analysis of our experience and review of the relevant literature

“…In regarding to the impaired renal function for this case, we chose laser lithiasis instead of ESWL to fragment the stone,since the former is more effective and less impact on the allograft function. Due to the proficiency in endourological technique, a modified mini-PCNL proposed by some authors provides an excellent treatment alternative [12,41]. This technique should be recommended in well equipped centers with experienced surgeons since it can minimize the injury risk of the interlobar arteries of the transplanted kidney [42].…”