title: Management of urolithiasis in live-related kidney donors.
abstract: OBJECTIVE
  To analyze our experience in management of urolithiasis in renal donors.
  
  
  METHODS
  The stones were treated either pretransplant or posttransplant. The Amsterdam forum criteria for acceptance of living donors were used for donor selection. The donors underwent the following procedures: pretransplant extracorporeal shock wave lithotripsy (ESWL) (n=5), pretransplant retrograde intrarenal surgery (RIRS) (n=1), ex-vivo ureteroscopy (ex-vivo URS) (n=1), and ex-vivo pyelolithotomy (ex-vivo Pyl) (n=2); intraoperative Double-J stent; and observation (n=3). Data were analyzed for technical feasibility, intraoperative and postoperative complications, and stone clearance.
  
  
  RESULTS
  The male and female ratio was 4:8 and average age was 52.3 years (38-71). In the pretransplant ESWL group, average of 740 shocks (600-1500) was given; the power was not ramped up beyond 12 kV. Ex-vivo URS was performed on bench with 6F pediatric cystoscope, while in the ex-vivo Pyl, a 12F nephroscope was introduced via a pyelotomy and stones were retrieved intact with a dormia basket. A postoperative ultrasound at one month revealed complete clearance of stones in all except one donor. At a mean follow-up of 36 months (10-58), there was no stone recurrence in donor or recipient.
  
  
  CONCLUSIONS
  This report shows the feasibility and safety of ex-vivo URS and ex-vivo Pyl in living donors, in select cases with subcentimeter calculi, an option of conservative management with Double-J stent is safe. ESWL/RIRS can be performed safely in the pretransplant setting. Proper donor selection and follow-up are crucial to success. We propose a treatment selection algorithm for management of these donors.
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India.
authors.forename: Arvind
authors.initials: A
authors.lastname: Ganpule
authors.forename: Jigish B
authors.initials: JB
authors.lastname: Vyas
authors.forename: Chetan
authors.initials: C
authors.lastname: Sheladia
authors.forename: Shashikant
authors.initials: S
authors.lastname: Mishra
authors.forename: Sanika A
authors.initials: SA
authors.lastname: Ganpule
authors.forename: R B
authors.initials: RB
authors.lastname: Sabnis
authors.forename: Mahesh
authors.initials: M
authors.lastname: Desai
mesh_terms: D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008096:Lithotripsy; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018666:Ureteroscopy; D052878:Urolithiasis / Q000097:blood / Q000000981:diagnostic imaging / Q000628:therapy*
chemical_list: D003404:Creatinine