Shockwave Lithotripsy for De-Novo Urolithiasis after Kidney Transplantation: A Systematic Review of the Literature

Abstract

Background: Allograft urolithiasis is an uncommon, challenging, and potentially dangerous clinical problem. Treatment of allograft stones includes external shockwave lithotripsy (SWL), flexible ureteroscopy and lasertripsy (fURSL), or percutaneous nephrolithotomy (PCNL). A gap in the literature and guidelines exists regarding the treatment of patients in this setting. The aim of this systematic review was to collect preoperative and treatment characteristics and evaluate the outcomes of post-transplant SWL for stone disease. Methods: A systematic search in the literature was performed, including articles up to March 2023. Only original English articles were selected. Results: Eight articles (81 patients) were included in the review. Patients were mainly male, with a mean age of 41.9 years (±7.07). The mean stone size was 13.18 mm (±2.28 mm). Stones were predominantly located in the kidney (n = 18, 62%). The overall stone-free rate and complication rates were 81% (range: 50–100%) and 17.2% (14/81), respectively, with only one major complication reported. A pre-operative drainage was placed in eleven (13.5%) patients. Five patients (6.71%) required a second treatment for residual fragments. Conclusions: SWL is a safe and effective option to treat de novo stones after transplantation. Larger studies are needed to better address allograft urolithiasis management.

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

“…Primary indications include small-to-medium sized stones (<1.5 cm), located at the ureter and kidney, except for the lower pole. Two systematic reviews investigating SWL in transplant kidneys reported SFRs of 75% at 3 months [ 59 ] and 80% at varying follow-up times [ 89 ]. Although SWL is minimally invasive, the anatomical position of the graft kidney close to the iliac bone could attenuate the shock waves and decrease the effectiveness of the procedure [ 47 , 52 , 90 ].…”

Urological Guidelines for Kidney Stones: Overview and Comprehensive Update

“…In addition, URS performed at experienced centres has also been demonstrated to be a safe technique, with good outcomes for both donor and post-transplanted kidneys [36]. Finally, SWL, although infrequently utilised for de novo lithiasis in transplant patients, has also been proven to be potent, with a low risk of major complications [37].…”