title: Endoscopic treatment of bladder calculi in post-renal transplant patients: a 10-year experience.
abstract: OBJECTIVE
  Urinary calculus formation following renal transplantation is an uncommon phenomenon. As a result of the growing number of renal transplants performed and the greater graft survival, there has been increased awareness of transplant-related complications, one of which is calculus formation. We report our experience in the management of bladder calculi after renal transplantation.
  
  
  METHODS
  We retrospectively reviewed the charts of 500 consecutive renal transplant patients from 1992 through 2002 and encountered 7 who had bladder calculi postoperatively. Ureteroneocystostomy had been performed using polyglactic acid suture. Bladder calculi were treated endoscopically by litholapaxy, electrohydraulic lithotripsy (EHL), or holmium:YAG laser lithotripsy.
  
  
  RESULTS
  Three calculi were found incidentally at the time of stent removal, and the others were associated with hematuria (43%), urinary tract infection (14%), or irritative voiding symptoms (14%). Eighty-six percent of the calculi were close to the allograft ureteral orifice.
  
  
  CONCLUSIONS
  While various forms of lithotripsy were employed in treating bladder calculi, Hol:YAG laser lithotripsy appeared to be both efficacious and safe. Both EHL and litholapaxy were complicated by mucosal bleeding necessitating Bugbee fulguration. Holmium:YAG laser lithotripsy was not associated with mucosal bleeding, and fulguration was not required near the allograft ureteral orifice. In addition, ureteral stenting is not required. Bladder calculi may form over both absorbable and nonabsorbable suture material, and the ideal suture for the ureteroneocystostomy has yet to be found. Until then, the Hol:YAG laser should be the lithotrite of choice for bladder calculi following renal transplantation.
authors.affiliation: Department of Urology, University Hospital at Stony Brook, Stony Brook, New York 11794-8093, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Lipke
authors.forename: David
authors.initials: D
authors.lastname: Schulsinger
authors.forename: Yefim
authors.initials: Y
authors.lastname: Sheynkin
authors.forename: Zelik
authors.initials: Z
authors.lastname: Frischer
authors.forename: Wayne
authors.initials: W
authors.lastname: Waltzer
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D004724:Endoscopy; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008096:Lithotripsy; D017602:Lithotripsy, Laser; D008875:Middle Aged; D001744:Urinary Bladder Calculi / Q000209:etiology / Q000601:surgery / Q000628:therapy*