Results of minimally invasive surgical treatment of allograft lithiasis in live-donor renal transplant recipients: a single-center experience of 3758 renal transplantations

Abstract

Allograft lithiasis is a rare urologic complication of renal transplantation (RT). Our aim is to present our experience with minimally invasive surgical treatment of allograft lithiasis in our series of live-donor renal transplant recipients. In a retrospective analysis of 3758 consecutive live-donor RTs performed in our center between November 2009 and January 2017, the results of minimally invasive surgery for the treatment of renal graft lithiasis diagnosed at follow-up were evaluated. Twenty-two (0.58%) patients underwent minimally invasive surgery for renal graft lithiasis. The mean age was 41.6 years, and duration between RT and surgical intervention was 27.3 months (range 3-67). The mean stone size was 11.6 mm (range 4-29). Stones were located in the urethra in 1, bladder in 2, ureter in 9, renal pelvis in 7 and calices in 3 patients. Surgical treatment included percutaneous nephrolithotomy in 1, cystoscopic lithotripsy in 3, flexible ureteroscopic lithotripsy in 6 and rigid ureteroscopic lithotripsy in 12 patients. No major complications were observed. One patient (4.5%) who underwent flexible ureteroscopy developed postoperative urinary tract infection. All patients were stone-free except two (9%) patients who required a second-look procedure after flexible ureteroscopic lithotripsy for residual stones. Stone recurrence was not observed in any patient during a mean follow-up duration of 30.2 months (range 8-84). Renal transplant lithiasis is uncommon and minimally invasive surgical treatment is rarely performed for its treatment. Endourological surgery may be performed safely, effectively and with a high success rate in these patients.

Flexible Ureteroscopy as the New Standard for the Management of Renal Transplant Urolithiasis <15 mm: A Single-Center Experience

“…Most recently, Sarier et al reported the use of minimally invasive surgical treatment of allograft lithiasis in 22 patients, including cystolitholapaxy, flexible and semirigid ureteroscopy, and PCNL, with no major postoperative complications and a stone-free rate of 89%. 15 There are some limitations to our study. Stone analysis data were only reported in 5 out of 18 patients.…”

“…[10][11][12] However, the continued advancement in endoscopic technology has made ureteroscopy more feasible. [13][14][15] Toward this end, we report our experience with ureteroscopy for the treatment of urolithiasis in the transplant kidney and ureter.…”

Endourological approach in patients with anatomical urinary tract challenges

“…Since there are no established criteria for surgical treatment of allograft lithiasis, 12,13 urologists tend to adapt guidelines approved for the management of urolithiasis in the general population, with the endourological approach becoming increasingly performed. 12 In this study, the efficiency of a minimally invasive approach was observed, since all graft stones patients were treated with a PNL (one patient) or a combined approach (two patients), and all but one were rendered completely stone free.…”

Update on the Management of Urological Problems Following Kidney Transplantation

“…The management of allograft lithiasis is the same whether it occurs de novo or is donor-gifted. Renal transplant lithiasis is often asymptomatic, which may be due to denervation of the graft [51,52]. The most common symptoms associated with posttransplant urolithiasis are unexplained fever, elevated Cr level, reduced urine output, and hematuria.…”

“…In a study by Dadkhah et al [53] comparing 2 UNC techniques, it was reported that the posterolateral extravesical UNC technique can be used to achieve easy and safe access to the upper urinary tract in kidney transplant recipients. In a series presented by Sarier et al [52], renal pelvic stones were easily removed from 2 pa-tients' transplanted kidneys using the modified Lich-Gregoir technique performed with only rigid URS without the need for flexible URS because a suitable passage to the upper urinary tract was established.…”