EAU 2018: Micro-Nephrolithotomy in a Transplanted Kidney: A Peculiar Indication for a Niche Procedure

Copenhagen, Denmark (UroToday.com) Percutaneous nephroLithotomy (PCNL) is a commonly performed procedure for large kidney stones. Several modifications of PCNL technique have been proposed and widely implemented into clinical practice.

Performing a PCNL procedure is challenging. If patients have some anatomical deviations from the norm, this procedure becomes even more harder given the structural surrounding of the kidney. Even slight deviation in the anatomy can lead to bowel perforations, bleeding complications leading to significant patient morbidity. 

Dr. S. P. Zanetti, a clinical urologist from the University of Milan, Department of Urology, presented on an anomalous case that utilized micro-nephrolithotomy in a transplanted kidney. MicroPCNL is a magnificent technique for those who cannot undergo a traditional PCNL. It is described as a treatment for solitary renal stones of small volume (<1000mm3) and low density (HU) regardless of stone location. It is performed using a 3-component needle (4.85F). The 3-way connector allows connection of radiation, fiber optic, and fiber, allowing for very high image quality.

The singular case of a 64-year-old man with end stage renal disease in kidney transplanted from a cadaveric donor was examined. During pre-transplant evaluations, a 7mm stone was found. After anastomosis, procession to stone removal was exhibited. Subsequent endoscopy through urethral access sheath allowed access into narrow calyx, where access to the stone was not possible before. 

Afterwards, MicroPCNL was used in recovery process. The kidney access was obtained under ultrasound control. Laser lithotripsy was used to fragment the stone and a Double J stent was placed at the end of the procedure. A month later, the stent was removed and an ureteroscopic examination at 45 days after the procedure showed no evidence of residual fragments. 

In conclusion, MicroPCNL is an attractive strategy that should be integrated into an endourologist’s armamentarium.

Presented by:Stefano P. Zanetti, MD University of Milan, Department. of Urology

Co-Authors: Sampogna G.1, De Lorenzis E.1 , Boeri L.1 , Gallioli A.1 , Palmisano F.1 , Fontana M.1 , Longo F.1 , Ferraresso M.2 , Montanari E.1
Author Information:1. University of Milan, Dept. of Urology, Milan, Italy, 2. University of Milan, Dept. of Renal Transplantation, Milan, Italy

Written by: Whitney Zhang and Zhamshid Okhunov, MD, Department of Urology, University of California-Irvine at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark