title: Decrease in and management of urolithiasis after kidney transplantation.
abstract: OBJECTIVE
  Urolithiasis after kidney transplantation can involve several contributing factors and the treatment strategy is open to question. We determined the incidence and management of urolithiasis in kidney recipients.
  
  
  METHODS
  We retrospectively reviewed a single center series of 3,000 kidney graft recipients during 32 years to identify those with urolithiasis. We analyzed data by the prevalence per decade, including perioperative procedures (preoperative assessment, anastomosis type and urinary drainage) and long-term followup (urinary stenosis, time to presentation, size, site, treatment type, renal function and survival).
  
  
  RESULTS
  We identified 31 cases and noted a significant decrease in incidence from 2.1% to 0.6% during the 3 decades. Excluding 4 cases of donor in situ stones the mean time to diagnosis was 8.5 years. Surgical risk factors were ureteral obstruction in 41% of cases, infravesical obstruction in 14% and urinary-digestive anastomosis in 14%. A total of 12 cases (38%) were observed exclusively with 2 of spontaneous passage. With minor adaptations all mini-invasive procedures, including extracorporeal shock wave lithotripsy, endoscopy and percutaneous nephrolithotomy, were feasible in graft recipients. Antegrade procedures were facilitated by the ventral position of the graft. Eight patients (25%) were treated with open surgical ureteroureteral anastomosis.
  
  
  CONCLUSIONS
  Prevention with a perioperative Double-J® stent and early treatment of ureteral obstruction have decreased and stabilized the urolithiasis rate at around 0.6%. Careful surveillance or any currently available instrumental treatments of urinary stones can be valid options.
authors.affiliation: Bicêtre Hospital, Paris South University, Le Kremlin Bicêtre, France.
authors.forename: Cecile
authors.initials: C
authors.lastname: Verrier
authors.forename: Thomas
authors.initials: T
authors.lastname: Bessede
authors.forename: Pascal
authors.initials: P
authors.lastname: Hajj
authors.forename: Lahbib
authors.initials: L
authors.lastname: Aoubid
authors.forename: Pascal
authors.initials: P
authors.lastname: Eschwege
authors.forename: Gerard
authors.initials: G
authors.lastname: Benoit
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D014517:Ureteral Obstruction / Q000453:epidemiology; D052878:Urolithiasis / Q000453:epidemiology* / Q000517:prevention & control / Q000628:therapy*