Intra-operative Postperfusion Micronephrolithotomy for Renal Allograft Lithiasis: A Case Report

Abstract

Intra-operative post-perfusion micro-nephrolithotomy for renal allograft lithiasis: a case report.Increasing demand drives the expansion of criteria for kidney donation and nephrolithiasis is now considered a relative contraindication. We report for the first time a case of intra-operative, postperfusion kidney allograft micro-nephrolithotomy. A 64-year-old man with end-stage renal disease secondary to Alport syndrome underwent primary deceased donor kidney transplantation at our centre.Pre-operative ultrasound of the donor identified a 7-mm calculus in the anterior, lower pole calyx. The kidney was extra-peritoneally implanted in the right iliac fossa and reperfused homogenously. Stone retrieval with a flexible ureteroscope failed due to the narrow calyceal infundibulum. Instead the calculus was removed using the microperc percutaneous nephrolithotomy system under ultrasonographic guidance. The calyx was punctured using a 4.85 Fr needle and the stone was fragmented to dust using a Holmium laser. No bleeding was observed. The post-operative course was uneventful. Outpatient follow up demonstrated good function of the graft which was stone free on ultrasound. Post-perfusion microperc nephrolithotomy for kidney allograft calculi offers a safe and feasible option when pre-operative or intra-operative retrograde intra-renal surgery fail.

Is There Still a Place for Percutaneous Nephrolithotomy in Current Times?

“…URS is often technically difficult due to the angle and position of the ureteroneocystostomy at the dome/anterior wall of the bladder and stone-free rates of 60–70% are reported in small case series [ 79 , 80 ]. PCNL is facilitated by the anterior position of the allograft kidney using ultrasound-guided or CT-guided puncture [ 81 ]. Antegrade access with a flexible ureteroscope is an option for managing ureteric stones to limit the dilatation required [ 82 ].…”