Ureteroscopy for transplant lithiasis.
OBJECTIVE
The optimal management of renal and ureteral calculi in transplanted kidneys is not well defined. Although larger (>1.5 cm) stone burdens are generally treated with percutaneous nephrolithotomy (PCNL), smaller stones may be reasonably approached with retrograde or antegrade ureteroscopy (URS). We report our multicenter experience with URS for transplant lithiasis.


METHODS
URS performed for stone disease within a transplanted kidney were retrospectively identified at three stone-referral centers between 2006 and 2011. Demographic and disease parameters were recorded, as were perioperative and postoperative details.


RESULTS
Twelve patients underwent URS for a calculus in a transplant renal unit and/or ureter. For retrograde procedures (7), access to the ureteral orifice was facilitated by the use of a Kumpe catheter; a two-wire (safety and working guidewire) technique was used. For antegrade procedures (5), the ureteroscope was passed into the kidney using a two-wire technique without tract dilation. All stones but one necessitated holmium:yttrium-aluminum-garnet laser lithotripsy with extraction of stone fragments. All patients were stone free on postoperative imaging except for one patient with a 2-mm fragment that was observed. Stone analysis included calcium oxalate (6), calcium phosphate (4), and struvite (1).


CONCLUSIONS
Antegrade and retrograde URS are safe and effective treatments for patients with simple stone burdens in a transplanted kidney. Although retrograde access to the ureter can be challenging, specialized techniques and modern endoscope technology facilitate this process. Antegrade URS for small stone burdens can be performed safely and effectively without tract dilation.
Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. eliash99@hotmail.com
Elias
E
Hyams
Tracy
T
Marien
Aron
A
Bruhn
Adrienne
A
Quirouet
Sero
S
Andonian
Ojas
O
Shah
Brian
B
Matlaga
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003710:Demography; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D018583:Pliability; D014513:Ureter / Q000000981:diagnostic imaging / Q000601:surgery; D014514:Ureteral Calculi / Q000000981:diagnostic imaging / Q000601:surgery*; D018666:Ureteroscopy / Q000379:methods*