There is a gap in the available literature and guidelines concerning the optimal approach for treating allograft stones, which currently include external shockwave lithotripsy, ureteroscopy and laser lithotripsy, or percutaneous nephrolithotomy. The objective of this systematic review was to evaluate the safety and effectiveness of URS as a treatment option for patients in this scenario.
A comprehensive search of the literature was conducted until August 2023. Only original articles written in English were considered for inclusion. This review has been registered in PROSPERO (registration number CRD42023451154).
Eleven articles were included (122 patients). The mean age was 46.9±9.5 years, with a male-to-female ratio of 62:49. The preferred ureteral reimplantation technique was the Lich-Gregoire. The mean onset time was 48.24 months. Acute kidney injury, urinary tract infections and fever were the most frequent clinical presentations (18.3% each), followed by hematuria (10%). The mean stone size measured 9.84 mm (±2.42 mm). Flexible URS was preferred over semirigid URS. The stone-free rate stood at 83.35%, while the overall complication rate was 13.93%, with six (4.9%) major complications reported. Stones were mainly composed of calcium oxalate (42.6%) or uric acid (14.8%). Over an average follow-up period of 30.2 months, the recurrence rate was 2.46%. No significant changes in renal function or allograft loss were reported.
URS remains an efficient choice for addressing de-novo allograft urolithiasis, offering the advantage of treating urinary stones with a good SFR and a low incidence of complications. Procedures should be performed in an Endourology referral center.
Minerva urology and nephrology. 2024 May 31 [Epub ahead of print]
Clara Cerrato, Carlotta Nedbal, Victoria Jahrreiss, Francesco Ripa, Vincenzo DE Marco, Manoj Monga, Belthangady M Hameed, Peter Kronenberg, Amelia Pietropaolo, Nitesh Naik, Bhaskar Somani
University Hospital Southampton NHS Trust, Southampton, UK., Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy., Department of Urology, San Diego University of California, San Diego, CA, USA., Father Muller Medical College Hospital, Mangalore, India., Hospital CUF Descobertas, Lisbon, Portugal., Manipal Institute of Technology, Manipal, India., University Hospital Southampton NHS Trust, Southampton, UK - .