Urolithiasis in allograft kidneys

Klingler, H. Christoph; Kramer, Gero; Lodde, Michele; Marberger, Michael

doi:10.1016/s0090-4295(01)01575-8

Cited by 104 publications

(101 citation statements)

References 11 publications

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“…13 Extracorporeal shock wave lithotripsy can be used; however, targeting the shock wave directly onto the stone can be difficult due to the proximity of the bony pelvis. 14 Ureteroscopic approaches are also possible, but can be challenging as the neo-ureteric orifice is often superior in the bladder and difficult to access.…”

Section: Discussionmentioning

confidence: 99%

“…14 Ureteroscopic approaches are also possible, but can be challenging as the neo-ureteric orifice is often superior in the bladder and difficult to access. 13 Additionally, the absence of native connective tissue may increase the risk of ureteral injury during instrumentation. 14 Traditional and tubeless PCNL are safe and effective in transplanted kidneys, but there are unique considerations .8,15 With the graft located in the iliac fossa, access is typically by way of an anterior calyx with the patient in a supine position.…”

Section: Discussionmentioning

confidence: 99%

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Outpatient percutaneous nephrolithotomy in a renal transplant patient: World’s first case

McAlpine

Leveridge

Beiko

2015

CUAJ

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Percutaneous nephrolithotomy (PCNL) is an established safe and effective surgical treatment option for renal calculi in renal allografts. The advent of tubeless PCNL has led to reports of ambulatory or outpatient PCNL. This case report describes the successful outpatient management of a 49-year-old female with a symptomatic renal pelvic calculus in her transplanted kidney. Tubeless PCNL successfully removed the stone, free of complication, and the patient was discharged 2 hours and 17 minutes after the procedure in stable condition with minimal pain. This is, to the best of our knowledge, the first successful case of outpatient tubeless PCNL in a transplanted kidney. IntroductionPercutaneous nephrolithotomy (PCNL) is an accepted and widely used approach to extract large renal calculi. Since its description in the 1970s, 1 surgical and technological advances have obviated the need for routine nephrostomy tube placement.2-8 Tubeless PCNL, with ureteral stenting, has been shown to decrease patients' analgesic requirements and hospital length of stay.9,10 Although hospitalization is standard practice after PCNL, reports have described success with outpatient management. 11,12 This case report is the first to describe successful outpatient PCNL in a renal transplant patient. Case reportA 49-year-old female presented to her community hospital with hematuria and lower abdominal pain over the preceding 48 hours. She had received her second cadaveric kidney transplant 6 years previously for end-stage renal disease of unknown etiology. On presentation she was afebrile and hemodynamically stable. Urine was positive for blood, but negative for nitrites or pyuria. Creatinine was 164 μmol/L (estimated glomular filtration rate 29 mL/min/1.73m 2 ), slightly elevated from her baseline of 150 μmol/L. An ultrasound scan showed a large renal stone in the lower pole of the allograft kidney. Intravenous antibiotics were initiated and the patient was transferred to our tertiary care centre.At our institution, a computed tomography scan revealed a 14 × 12 × 11-mm stone located in the renal pelvis (Fig. 1a, Fig. 1b). There was mild hydronephrosis, yet the parenchyma of the graft was preserved. There was no evidence of a urinary tract infection (UTI)/sepsis and the patient's pain responded to oral analgesia. The surgical options were discussed and a decision was made to proceed with the PCNL. Informed consent was obtained and a 1-week course of levofloxacin was prescribed for UTI prophylaxis.On the morning of the procedure, a stress dose of 100 mg intravenous (IV) hydrocortisone was administered. Cefazolin 1 g IV was given prior to induction of general anesthesia. Flexible cystourethroscopy was performed and a 5Fr openended ureteral catheter was passed up the left transplanted ureteral orifice over a 0.035" guidewire. A Foley catheter was placed to straight drainage and the patient was repositioned supine for percutaneous access. Retrograde ureteropyelography outlined the allograft kidney's collecting system, demonstrating renal...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Outpatient percutaneous nephrolithotomy in a renal transplant patient: World’s first case

McAlpine

Leveridge

Beiko

2015

CUAJ

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“…Sunulan olguda PUV mesanesine bağlı üreter komplikasyonu riski düşünülerek DJS yerleştirilmiştir. Böbrek nakli hastalarında taş hastalığı için risk faktörleri fazla olmasına karşılık nakil böbrekte taş görülme oranı normal populasyondan daha düşük olup %0,2-%1,7 arasında rapor edilmektedir (6,7). Allograft böbrekte stent unutulması, taş ve obstrüksiyon oluşması çok ciddi morbiditeye, nadir de olsa mortaliteye sebep olabilir.…”

Section: Discussionunclassified

“…Enkrüstasyon üreteral stentlerin en ciddi komplikasyonudur ve çıkarılması çoğu zaman tecrübeli endoürologlar için bile zor olgulardır (8). ESWL (Extracorporeal Shock Wave Lithotripsy) taş yükü az olan (5-15 mm) olgularda makul bir seçenek olabilir (6). Ancak böbreğin kemik pelviste olması nedeni ile pozisyon vermede sorun olması, soliter böbrekte obstrüksiyon ve rezidü taş riski nedeniyle nakil böbreklerin tedavisinde kullanımı sınırlıdır.…”

Section: Discussionunclassified

Management of Encrusted Ureteral Stent with Mini Percutaneous Nephrolithotomy in Patient with Kidney Transplantation

Aki¹,

Koni²,

Bilen³

et al. 2010

Turk Neph Dial Transpl

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ÖZÜreter stentleri böbrek nakli yapılan hastalarda ürolojik komplikasyonları azaltmak için sıklıkla kullanılmaktadır. Ancak böbrek nakilli hastalarda stent kullanımı ciddi komplikasyonlara neden olabilir. Stent enkrüstasyonu üreteral stentlerin en ağır komplikasyonudur. Bu yazıda böbrek nakli sırasında yerleştirilen bir üreteral stentte kısa sürede gelişen enkrüstasyon olgusu bildirilmiştir. Posterior üretral valv nedeni ile son dönem böbrek yetmezliği gelişen 12 yaşında bir hastaya kadavradan yapılan böbrek nakli sırasında üretere double J stent yerleştirilmiştir. Düşük moleküler ağırlıklı heparin ile antikoagülan tedavi alan hastanın 6 hafta sonra stenti çekilmek istendiğinde ciddi kalsifikasyon olduğu gözlenmiş ve stent çıkarılamamıştır. Bunun üzerine önce kateterin mesane tarafında oluşan taşlar in situ kırılarak temizlenmiş daha sonra mini perkütan nefrolitotomi uygulanmıştır. Stent etrafında ve böbrekte oluşan taşlar çıkarıldıktan sonra double J stent perkütan olarak çıkarılmıştır. Enkrüste üreter stentlerinin çıkarılması her zaman zordur. Antikoagülan tedavi alan hastalarda ve böbrek nakli hastalarında komplikasyon riski daha yüksektir. Mini perkütan nefrolitotomi bu hastalarda daha düşük komplikasyon riski ile birlikte başarı ile uygulanabilir. Üreter stentleri, komplikasyonlarından korunmak için kliniğimizde sadece komplikasyon riski yüksek seçilmiş olgularda kullanılmaktadır.ANAHTAR sÖZCüKLER: Böbrek nakli, Stent, Komplikasyon, Taş hastalığı ABsTRACTUreteric stents has been widely used in kidney transplantation practice to decrease major urologic complications. However ureteral stenting is associated with some specific complications in patients with kidney transplantation. A case of a renal transplantation patient whose ureteral stent was heavily encrusted is reported. A 12-year-old boy with end stage renal disease secondary to posterior urethral valve received a cadaveric renal transplantation. A ureteral double J stent was placed peroperatively. The patient was anticoagulated with low molecular weight heparin postoperatively. Stent encrustation was noticed during cystoscopy and the stent could not be removed. Following cystolithotripsy, the kidney stones and ureteric stents were removed successfully with mini percutaneous nephrolithotomy. The removal of an encrusted ureteric stent is always a urological challenge. The complication risk is even higher in patients receiving anticoagulation therapy and with kidney transplantation. Mini percutaneous nephrolitotomy techniques can be employed successfully with a lower complication risk. Selective stenting is preferred in our clinic to avoid the specific complications of ureteric stents. GİRİŞSon dönem böbrek yetmezliğinin günümüzde en iyi tedavi yöntemi böbrek naklidir. İdrar kaçağı, obstrüksiyon gibi major ürolojik komplikasyonlar nakil sonrası önemli morbidite nedenleri arasındadır. Son yıllarda yeni immünsupresif tedavi protokollerinin kliniklere girmesi ve cerrahi tekniklerin gelişmesi ile ürolojik komplikasyonların görülme sıklığı azalmış olup %5-%10...

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“…2 And also, the proximity to the bony pelvis causes that targeting the shock wave directly onto the stone becomes more difficult in ESWL. 1,4,9,10,22 But the anatomic position in the iliac fossa with the renal surface close to skin makes PCNL an attractive alternative and a feasible procedure in the treatment of urinary calculi. 10 Many cases have been reported in which allograft lithiass was treated successfully with PCNL.…”

Section: 391121mentioning

confidence: 99%

Tubeless percutaneous nephrolithotomy (pcnl) in renal allografts: a case report and mini-review

et al. 2016

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Urinary lithiasis in transplanted kidney is a relatively uncommon complication. However, it may lead to a significant morbidity and loss of renal function. The report presents the case of a 32-year-old male renal-transplant recipient, with a stone in renal pelvis who was treated successfully by tubeless percutaneous nephrolithotomy (PCNL). The patient is currently stone free with no complication. This article also reviews in brief the treatment of this rare complication. Reviewing the literature showed, it could be noticed that PCNL is a safe and feasible procedure for treating nephrolithiasis in a transplanted kidney.

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Urolithiasis in allograft kidneys

Cited by 104 publications

References 11 publications

Outpatient percutaneous nephrolithotomy in a renal transplant patient: World’s first case

Outpatient percutaneous nephrolithotomy in a renal transplant patient: World’s first case

Management of Encrusted Ureteral Stent with Mini Percutaneous Nephrolithotomy in Patient with Kidney Transplantation

Tubeless percutaneous nephrolithotomy (pcnl) in renal allografts: a case report and mini-review

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