Department of Urology, University of California, San Francisco, School of Medicine, San Francisco, California.

Stone disease is a rare complication after renal transplantation, and the management of these stones can be difficult. In many cases, the best modality to treat stones in transplanted kidneys/ureters is with a percutaneous approach. The goal of this study was to review our series of percutaneous nephrolithotomy (PNL) to evaluate the success rates and present the key technical points to achieve a successful outcome.

We retrospectively reviewed our series of PNL from January 1997 to December 2007 and identified 15 patients who had had PNL performed in a transplanted kidney. We evaluated multiple perioperative variables and how the patients' urolithiasis presented. We also collected intraoperative data.

A total of 15 patients underwent successful PNL in a transplanted kidney. In all patients, but 3, access into an anterior, upper pole calix was achieved, and access was obtained with ultrasound guidance alone or a combination of ultrasound guidance and fluoroscopy. Ten patients had a pre-existing nephrostomy tube, and this was used in all but 1 patient. Of the 15 patients, 8 (53%) were treated with percutaneous flexible nephroscopy/ureteroscopy, and 7 had tracts dilated to 30F to perform rigid PNL. All patients were rendered stone free at the end of the procedure, no complications developed, and no patient required a blood transfusion.

Nephrolithiasis in a transplanted kidney can be challenging to diagnose and to treat. PNL is most often the best modality to render patients stone free.

Written by
Rifaioglu MM, Berger AD, Pengune W, Stoller ML.

Reference
Urology. 2008 Jul 22. Epub ahead of print.
doi:10.1016/j.urology.2008.05.040

PubMed Abstract
PMID:18653217

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