Percutaneous management of stones in transplanted kidneys.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Rifaioglu
Murat M
MM
Department of Urology, University of California, San Francisco, School of Medicine, San Francisco, California 94143, USA.
Berger
Aaron D
AD
Pengune
Witsanu
W
Stoller
Marshall L
ML
D000328:Adult; D000368:Aged; D005260:Female; D005355:Fibrosis; D006801:Humans; D007669:Kidney Calculi / Q000209:etiology* / Q000628:therapy*; D007670:Kidney Calices / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014572:Urology / Q000379:methods*