Percutaneous Management of Stones in Transplanted Kidneys

Markić, Dean; Krpina, Kristian; Ahel, Juraj; Gršković, Antun; Španjol, Josip; Rubinić, Nino; Materljan, Mauro; Mikolašević, Ivana; Orlić, Lidija; Rački, Sanjin

doi:10.1016/j.urology.2008.05.040

Cited by 44 publications

(39 citation statements)

References 22 publications

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“…In addition, various urologic risk factors have been identified, including infection by urea-splitting microorganisms, voiding dysfunction, retained double J stents, infravesical obstruction, and ureteral obstruction. 14,16,23,24 The reported incidence of 1.3% in our series is comparable to the rates reported in the literature. 19,21,24 Recently, a decline in the rate of urolithiasis was reported by Verrier and associates until it had stabilized around 0.6%.…”

Section: Discussionsupporting

confidence: 88%

“…The bleeding risk can also be increased by platelet dysfunction in the early transplant period from preexisting renal failure. 14 We reported excessive urinary leakage after PCN removal. This could have been prevented by antegrade double J stent fixation during the procedure.…”

Section: Discussionmentioning

confidence: 86%

“…3 Similarly, this policy has been reported in many series, although this was judged only by surgeon opinion with no specified characteristics. 14,19 Martin and associates acknowledged conservative treatment for stones of < 4 mm in the presence of good diuresis. 25 Although the stones reported in their study were from the donor graft, this principle can be applied to de novo allograft stones.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 Many risk factors have been identified for de novo stone development in the recipient side, including urologic and metabolic factors. [13][14][15] Furthermore, multimodal management options have been reported in the literature, particularly the use of percutaneous nephrolithotomy (PNL) in clearing allograft lithiasis. [13][14][15][16][17] Nevertheless, because the incidence is relatively low, data are still lacking and further investigations are warranted.…”

Section: Introductionmentioning

confidence: 99%

“…[13][14][15] Furthermore, multimodal management options have been reported in the literature, particularly the use of percutaneous nephrolithotomy (PNL) in clearing allograft lithiasis. [13][14][15][16][17] Nevertheless, because the incidence is relatively low, data are still lacking and further investigations are warranted. In addition, there is a paucity of data about the long-term outcomes regarding the effects of PNL on graft outcomes and stone recurrence.…”

Section: Introductionmentioning

confidence: 99%

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2017

Exp Clin Transplant

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Objectives: We report on the long-term follow-up of managing allograft stones at a single tertiary referral institution and review the relevant literature. Materials and Methods: A retrospective analysis of renal allograft recipient charts was performed to identify patients who developed allograft lithiasis between 1974 and 2009. Patient and stone characteristics, diagnoses, treatments, and outcomes were described. Results: Sixteen patients developed 22 stones after a median follow-up of 170 months (range, 51-351 mo). The mean (standard deviation) and median diameter of the stones were 13.8 (8.5) mm and 11 mm. Among these, 3 stones were treated conservatively, 3 by shock-wave lithotripsy, and 7 by cystolitholapaxy. Seven patients underwent percutaneous treatment in the form of percutaneous nephrostomy tube fixation and spontaneous passage of stone (1 stone), shock-wave lithotripsy (1 stone), antegrade stenting (1 stone), and percutaneous nephrolithotomy (6 stones). All patients were stone free after treatment, except for 2 patients whose stones were stable and peripheral on long-term follow-up. Conclusions: Allograft lithiasis requires a multimodal treatment tailored according to stone and graft characteristics. Protocols regarding spontaneous passage can be adopted if there is no harm to the graft and the patient is compliant. Careful attention to the anatomy during percutaneous nephrostomy tube placement is mandatory to avoid intestinal loop injury. A more attentive follow-up is required for early stone management.

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