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Solano C, Corrales M, Panthier F, Doizi S, Traxer O. Comprehensive Approaches to Urolithiasis in Renal Transplants: A Narrative Review. J Clin Med 2024; 13:4268. [PMID: 39064308 PMCID: PMC11278228 DOI: 10.3390/jcm13144268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 06/18/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
This review addresses the management of urolithiasis in renal transplant recipients, a notably vulnerable group due to the unique anatomical and physiological alterations of the transplanted organ. The prevalence of nephrolithiasis in these patients varies between 0.1% and 6.3%, with a significant impact on graft longevity and function. Surgical access complications due to the renal graft's position on the iliac vessels and the variety of urinary anastomoses complicate the treatment approaches. This study evaluates the effectiveness and outcomes of percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS), two primary minimally invasive strategies for managing graft stones. Through a narrative review using the PubMed and EMBASE databases, it was found that PCNL offers high stone-free rates especially beneficial for large stones, whereas URS provides a less invasive option with a lower risk of complications for small stones. Both techniques require tailored approaches based on stone composition-mostly calcium oxalate-and specific patient anatomical factors. This review underscores the importance of early diagnosis, appropriate treatment selection, and continuous post-treatment monitoring to mitigate risks and promote long-term renal function in transplant recipients.
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Affiliation(s)
- Catalina Solano
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Tenon Hospital, Sorbonne University, 75020 Paris, France; (M.C.); (F.P.); (S.D.); (O.T.)
- Uroclin S.A.S., Department of Endourology, Medellín 050021, Colombia
| | - Mariela Corrales
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Tenon Hospital, Sorbonne University, 75020 Paris, France; (M.C.); (F.P.); (S.D.); (O.T.)
| | - Frédéric Panthier
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Tenon Hospital, Sorbonne University, 75020 Paris, France; (M.C.); (F.P.); (S.D.); (O.T.)
| | - Steeve Doizi
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Tenon Hospital, Sorbonne University, 75020 Paris, France; (M.C.); (F.P.); (S.D.); (O.T.)
| | - Olivier Traxer
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Tenon Hospital, Sorbonne University, 75020 Paris, France; (M.C.); (F.P.); (S.D.); (O.T.)
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Lo CYZ, Chong D, Sjariffudin IF, Chong TW, Lu Y. Percutaneous nephrolithotomy for adult renal transplant de novo graft lithiasis: a single center analysis and systematic review of the literature. World J Urol 2024; 42:373. [PMID: 38869666 DOI: 10.1007/s00345-024-05079-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/23/2024] [Indexed: 06/14/2024] Open
Abstract
INTRODUCTION/OBJECTIVE Graft stones in renal transplant recipients pose a unique challenge, finding effective interventions to ensure optimal graft function and patient well-being. Various methods of stone clearance have been described for graft stones, including percutaneous nephrolithotomy (PCNL). While PCNL is a promising approach for managing graft stones, specific outcomes and associated characteristics for this approach have not been comprehensively evaluated before. This study aims to evaluate the safety and efficacy of the use of PCNL as the primary intervention of graft stones by assessing stone-free rates (SFR), treatment impact on graft function, and perioperative complications. METHODS A retrospective clinical audit was performed for all transplants performed in a single center from 2007 to 2022, which included all graft lithiasis patients who were treated with PCNL. Both perioperative parameters and post-operative outcomes were collected. In addition, a systematic review including articles from MEDLINE, Embase, Web of Science yielded 18 full-text articles published between 1/1/2000 and 15/11/2023. The results pertaining to patients who underwent PCNLs for graft stones were cross-referenced and thoroughly evaluated. The review encompassed a comprehensive analysis of clinical data, postoperative outcomes, and procedural details. The protocol for the systematic review was prospectively registered on PROSPERO (CRD42023486825). RESULTS In our center, 6 graft lithiasis patients were treated with PCNL. The initial SFR was 83.3%. SFR at 3 months and 1 year were both 100.0%. SFR at 3 years was 66.7%. Other centers reported initial SFR of 82.6-100.0% (interquartile range). SFR at 3 months, 1 year, 3 years was not well reported across the included studies. Incidence of graft lithiasis ranged from 0.44%-2.41%. Most common presentations at diagnosis were oliguria/anuria/acute kidney injury and asymptomatic. Reported complications included blood loss, transient hematuria, high urine output, sepsis, and damage to surrounding structures. The most commonly reported metabolic abnormalities in transplant lithiasis patients included hyperuricemia and hyperparathyroidism. CONCLUSION PCNL is a practical and efficient choice for addressing graft lithiasis, demonstrating excellent stone clearance and minimal perioperative complications. These findings show the importance of PCNL as a primary intervention in this complex patient population.
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Affiliation(s)
| | - Dominic Chong
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore.
| | | | - Tsung Wen Chong
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Yadong Lu
- Department of Urology, Singapore General Hospital, Singapore, Singapore
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Cerrato C, Jahrreiss V, Nedbal C, Ripa F, Marco VD, Monga M, Hameed BMZ, Kronenberg P, Pietropaolo A, Naik N, Somani BK. Percutaneous Nephrolithotomy for De Novo Urolithiasis After Kidney Transplantation: A Systematic Review of the Literature. J Endourol 2024; 38:536-544. [PMID: 38545755 DOI: 10.1089/end.2023.0398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2024] Open
Abstract
Introduction and Objective: Renal transplantation is the treatment for end-stage renal disease that offers better quality of life and survival. Among the possible complications that might affect allografts, urolithiasis might have severe consequences, causing acute kidney injury (AKI) or septic events in immunocompromised patients. Allograft stones might be treated with percutaneous nephrolithotomy (PCNL). The aim of this Cochrane style review was to assess the safety and efficacy of PCNL in patients with renal transplant. Methods: A comprehensive search in the literature was performed including articles between July 1982 and June 2023, with only English original articles selected for this review. Results: The final review encompassed nine articles (108 patients). The mean age was 46.4 ± 8.7 years, with a male:female ratio of 54:44. The average time from transplantation to urolithiasis onset was 47.54 ± 23.9 months. Predominant symptoms upon presentation were AKI (32.3%), followed by urinary tract infection and fever (24.2%), and oliguria (12.9%). The mean stone size was 20.1 ± 7.3 mm, with stones located in the calices or pelvis (41%), ureteropelvic junction (23.1%), or proximal ureter (28.2%). PCNL (22F-30F) was more frequently performed than mini-PCNLs (16F-20F) (52.4% vs 47.6%). Puncture was guided by ultrasound (42.9%), fluoroscopy (14.3%), or both (42.9%). The stone-free rate (SFR) and complication rates were 92.95% (range: 77%-100%) and 5.5%, respectively, with only one major complication reported. Postoperatively, a ureteral stent and nephrostomy were commonly placed in 47%, with four patients needing a second look PCNL. During an average follow-up of 32.5 months, the recurrence rate was 3.7% (4/108), and the mean creatinine level was 1.37 ± 0.28 mg/dL. Conclusions: PCNL remains a safe and effective option in de novo allograft urolithiasis, allowing to treat large stones in one-step surgery. A good SFR is achieved with a low risk of minor complications. These patients should be treated in an endourology center in conjunction with the renal or transplant team.
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Affiliation(s)
- Clara Cerrato
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Victoria Jahrreiss
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- EAU Section on Urolithiasis (EULIS), Arnhem, The Netherlands
| | - Carlotta Nedbal
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
- Department of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Francesco Ripa
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Vincenzo De Marco
- Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Manoj Monga
- Department of Urology, University of California San Diego, San Diego, California, USA
| | - B M Z Hameed
- Father Muller Medical College Hospital, Mangalore, Karnataka, India
| | | | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group, Arnhem, The Netherlands
| | - Nithesh Naik
- Manipal Institute of Technology, Manipal, Karnataka, India
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
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Cerrato C, Nedbal C, Jahrreiss V, Ripa F, DE Marco V, Monga M, Hameed BM, Kronenberg P, Pietropaolo A, Naik N, Somani B. URS for de-novo urolithiasis after kidney transplantation: a systematic review of the literature. Minerva Urol Nephrol 2024; 76:286-294. [PMID: 38819386 DOI: 10.23736/s2724-6051.24.05683-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
INTRODUCTION There is a gap in the available literature and guidelines concerning the optimal approach for treating allograft stones, which currently include external shockwave lithotripsy, ureteroscopy and laser lithotripsy, or percutaneous nephrolithotomy. The objective of this systematic review was to evaluate the safety and effectiveness of URS as a treatment option for patients in this scenario. EVIDENCE ACQUISITION A comprehensive search of the literature was conducted until August 2023. Only original articles written in English were considered for inclusion. This review has been registered in PROSPERO (registration number CRD42023451154). EVIDENCE SYNTHESIS Eleven articles were included (122 patients). The mean age was 46.9±9.5 years, with a male-to-female ratio of 62:49. The preferred ureteral reimplantation technique was the Lich-Gregoire. The mean onset time was 48.24 months. Acute kidney injury, urinary tract infections and fever were the most frequent clinical presentations (18.3% each), followed by hematuria (10%). The mean stone size measured 9.84 mm (±2.42 mm). Flexible URS was preferred over semirigid URS. The stone-free rate stood at 83.35%, while the overall complication rate was 13.93%, with six (4.9%) major complications reported. Stones were mainly composed of calcium oxalate (42.6%) or uric acid (14.8%). Over an average follow-up period of 30.2 months, the recurrence rate was 2.46%. No significant changes in renal function or allograft loss were reported. CONCLUSIONS URS remains an efficient choice for addressing de-novo allograft urolithiasis, offering the advantage of treating urinary stones with a good SFR and a low incidence of complications. Procedures should be performed in an Endourology referral center.
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Affiliation(s)
- Clara Cerrato
- University Hospital Southampton NHS Trust, Southampton, UK
| | - Carlotta Nedbal
- University Hospital Southampton NHS Trust, Southampton, UK
- Polytechnic University of Marche, Ancona, Italy
| | - Victoria Jahrreiss
- University Hospital Southampton NHS Trust, Southampton, UK
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- EAU Section on Urolithiasis (EULIS), Arnhem, the Netherlands
| | - Francesco Ripa
- University Hospital Southampton NHS Trust, Southampton, UK
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Vincenzo DE Marco
- Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Manoj Monga
- Department of Urology, San Diego University of California, San Diego, CA, USA
| | | | | | - Amelia Pietropaolo
- University Hospital Southampton NHS Trust, Southampton, UK
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group, Arnhem, the Netherlands
| | - Nitesh Naik
- Manipal Institute of Technology, Manipal, India
| | - Bhaskar Somani
- University Hospital Southampton NHS Trust, Southampton, UK -
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Piana A, Basile G, Masih S, Bignante G, Uleri A, Gallioli A, Prudhomme T, Boissier R, Pecoraro A, Campi R, Di Dio M, Alba S, Breda A, Territo A. Kidney stones in renal transplant recipients: A systematic review. Actas Urol Esp 2024; 48:79-104. [PMID: 37574010 DOI: 10.1016/j.acuroe.2023.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Lithiasis in renal graft recipients might be a dangerous condition with a potential risk of organ function impairment. EVIDENCE ACQUISITION A systematic literature search was conducted through February 2023. The primary objective was to assess the incidence of lithiasis in kidney transplant (KT) recipients. The secondary objective was to assess the timing of stone formation, localization and composition of stones, possible treatment options, and the incidence of graft loss. EVIDENCE SYNTHESIS A total of 41 non-randomized studies comprising 699 patients met our inclusion criteria. The age at lithiasis diagnosis ranged between 29-53 years. Incidence of urolithiasis ranged from 0.1-6.3%, usually diagnosed after 12 months from KT. Most of the stones were diagnosed in the calyces or in the pelvis. Calcium oxalate composition was the most frequent. Different treatment strategies were considered, namely active surveillance, ureteroscopy, percutaneous/combined approach, or open surgery. 15.73% of patients were submitted to extracorporeal shock wave lithotripsy (ESWL), while 26.75% underwent endoscopic lithotripsy or stone extraction. 18.03% of patients underwent percutaneous nephrolithotomy whilst 3.14% to a combined approach. Surgical lithotomy was performed in 5.01% of the cases. Global stone-free rate was around 80%. CONCLUSIONS Lithiasis in kidney transplant is a rare condition usually diagnosed after one year after surgery and mostly located in the calyces and renal pelvis, more frequently of calcium oxalate composition. Each of the active treatments is associated with good results in terms of stone-free rate, thus the surgical technique should be chosen according to the patient's characteristics and surgeon preferences.
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Affiliation(s)
- A Piana
- Servicio de Urología, Hospital Romolo, Rocca di Neto, Italy; Departamento de Urología, Universidad de Turín, Turín, Italy.
| | - G Basile
- Unidad de Uro-oncología y Trasplante Renal, Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - S Masih
- Servicio de Urología, Centro Médico de la Universidad de Toledo, Toledo, OH, United States
| | - G Bignante
- Departamento de Urología, Universidad de Turín, Turín, Italy
| | - A Uleri
- Unidad de Uro-oncología y Trasplante Renal, Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - A Gallioli
- Unidad de Uro-oncología y Trasplante Renal, Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - T Prudhomme
- Servicio de Urología, Trasplante Renal y Andrología, Hospital Universitario de Rangueil, Toulouse, France
| | - R Boissier
- Servicio de Urología y Trasplante Renal, Hospital Universitario La Concepción, Marsella, France
| | - A Pecoraro
- Departmento de Medicina Experimental y Clínica, Universidad de Florencia, Florencia, Italy
| | - R Campi
- Departmento de Medicina Experimental y Clínica, Universidad de Florencia, Florencia, Italy
| | - M Di Dio
- Sección de Urología, Servicio de Cirugía, Hospital Annunziata, Cosenza, Italy
| | - S Alba
- Servicio de Urología, Hospital Romolo, Rocca di Neto, Italy
| | - A Breda
- Unidad de Uro-oncología y Trasplante Renal, Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - A Territo
- Unidad de Uro-oncología y Trasplante Renal, Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
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Cerrato C, Jahrreiss V, Nedbal C, Ripa F, De Marco V, Monga M, Pietropaolo A, Somani B. Shockwave Lithotripsy for De-Novo Urolithiasis after Kidney Transplantation: A Systematic Review of the Literature. J Clin Med 2023; 12:4389. [PMID: 37445423 DOI: 10.3390/jcm12134389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Allograft urolithiasis is an uncommon, challenging, and potentially dangerous clinical problem. Treatment of allograft stones includes external shockwave lithotripsy (SWL), flexible ureteroscopy and lasertripsy (fURSL), or percutaneous nephrolithotomy (PCNL). A gap in the literature and guidelines exists regarding the treatment of patients in this setting. The aim of this systematic review was to collect preoperative and treatment characteristics and evaluate the outcomes of post-transplant SWL for stone disease. METHODS A systematic search in the literature was performed, including articles up to March 2023. Only original English articles were selected. RESULTS Eight articles (81 patients) were included in the review. Patients were mainly male, with a mean age of 41.9 years (±7.07). The mean stone size was 13.18 mm (±2.28 mm). Stones were predominantly located in the kidney (n = 18, 62%). The overall stone-free rate and complication rates were 81% (range: 50-100%) and 17.2% (14/81), respectively, with only one major complication reported. A pre-operative drainage was placed in eleven (13.5%) patients. Five patients (6.71%) required a second treatment for residual fragments. CONCLUSIONS SWL is a safe and effective option to treat de novo stones after transplantation. Larger studies are needed to better address allograft urolithiasis management.
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Affiliation(s)
- Clara Cerrato
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
| | - Victoria Jahrreiss
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, 1090 Vienna, Austria
| | - Carlotta Nedbal
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
- Urology Unit, School of Urology, Faculty of Medicine, Università Politecnica delle Marche, 60121 Ancona, Italy
| | - Francesco Ripa
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, 20122 Milan, Italy
| | - Vincenzo De Marco
- Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, 37126 Verona, Italy
| | - Manoj Monga
- Department of Urology, University of California San Diego, San Diego, CA 92037, USA
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
- European Association of Urology-Young Academic Urologists (EAU-YAU), Urolithiasis and Endourology Working Group, NL-6803 AA Arnhem, The Netherlands
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
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Boissier R, Rodriguez-Faba O, Zakri RH, Hevia V, Budde K, Figueiredo A, García EL, Olsburgh J, Regele H, Yuan CY, Breda A. Evaluation of the Effectiveness of Interventions on Nephrolithiasis in Transplanted Kidney. Eur Urol Focus 2022:S2405-4569(22)00278-4. [PMID: 36567234 DOI: 10.1016/j.euf.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/08/2022] [Accepted: 11/16/2022] [Indexed: 12/25/2022]
Abstract
CONTEXT De Novo nephrolithiasis in renal transplant can have severe consequences since renal transplantation involves a single functioning kidney with medical and anatomical specificities (heterotopic transplantation on iliac vessels, immunosuppressive treatments, and comorbidities). OBJECTIVE To systematically review all available evidence on the prevalence of de novo nephrolithiasis in renal transplant, presentation, and stone characteristics, and to report in a meta-analysis the efficacy of stone treatments (extracorporeal shock wave lithotripsy [ESWL], medical treatment, percutaneous nephrolithotomy [PCNL], open surgery, and ureteroscopy). EVIDENCE ACQUISITION Medline, Embase, and the Cochrane Library were searched up to November 2021 for all relevant publications reporting the management of de novo nephrolithiasis in renal allografts. The primary outcome was stone-free rate (SFR) at 3 mo. Secondary outcomes included prevalence, stone characteristics (size, density, and composition), symptoms on presentation, need for drainage, complications, and recurrence. Data were narratively synthesized in light of methodological and clinical heterogeneity, and a meta-analysis was performed for SFR. The risk of bias of each included study was assessed. EVIDENCE SYNTHESIS We included 37 retrospective studies with 553 patients and 612 procedures; of the 612 procedures 20 were antegrade ureteroscopy, 154 retrograde ureteroscopy, 118 PCNL, 25 open surgery, 155 ESWL, and 140 surveillance/medical treatment. The prevalence of nephrolithiasis in renal transplant was 1.0%. The mean stone size on diagnosis was 11 mm (2-50). The overall SFR at 3 mo was 82%: 96% with open surgery, 95% with antegrade ureteroscopy, 86% with PCNL, 81% with retrograde ureteroscopy, and 75% with ESWL. CONCLUSIONS De novo nephrolithiasis in renal transplant is an infrequent condition. A high SFR were obtained with an antegrade approach (ureteroscopy, PCNL, and open approach) that should be considered in renal transplant patients owing to the heterotopic position of the renal graft. The choice of technique was correlated with stone size: generally ureteroscopy and ESWL for stones 11-12 mm (mean stone size) versus PCNL and open surgery for 17-25 mm stones. PATIENT SUMMARY De novo nephrolithiasis in renal transplants is an infrequent situation that can have severe consequences on the function of the renal graft. We evaluated the efficacy of each treatment and noted that antegrade approaches (open surgery, percutaneous nephrolithotomy, and antegrade ureteroscopy) were associated with the highest stone-free rate. As opposed to the management of nephrolithiasis in native kidney, an antegrade approach should be considered more in renal transplant patients.
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Affiliation(s)
- Romain Boissier
- Aix-Marseille University, Marseille, France; Department of Urology & Renal Transplantation, La Conception University Hospital, Assistance-Publique Marseille, France
| | - Oscar Rodriguez-Faba
- Department of Urology, Fundacion Puigvert, University Autonoma of Barcelona, Barcelona, Spain
| | - Rhana Hassan Zakri
- Department of Urology & Renal Transplantation Guy's and St Thomas' Hospital, London, UK
| | - Vital Hevia
- Urology Department, Hospital Universitario Ramón y Cajal, Alcalá University, Madrid, Spain
| | - Klemens Budde
- Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Arnaldo Figueiredo
- Department of Urology and Renal Transplantation, Coimbra University Hospital, Coimbra, Portugal
| | - Enrique Lledó García
- Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jonathon Olsburgh
- Department of Urology & Renal Transplantation Guy's and St Thomas' Hospital, London, UK
| | - Heinz Regele
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Cathy Yuhong Yuan
- Department of Medicine, Health Science Centre, McMaster University, Hamilton, Ontario, Canada
| | - Alberto Breda
- Department of Urology, Fundacion Puigvert, University Autonoma of Barcelona, Barcelona, Spain.
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Bolen E, Stern K, Humphreys M, Brady A, Leavitt T, Zhang N, Keddis M. Urine metabolic risk factors and outcomes of patients with kidney transplant nephrolithiasis. Clin Kidney J 2021; 15:500-506. [PMID: 35211306 PMCID: PMC8862062 DOI: 10.1093/ckj/sfab208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Background
Nephrolithiasis in allograft kidneys is rare, but this diagnosis may lead to allograft complications and patient morbidity. Previous studies that have evaluated nephrolithiasis posttransplant have focused on surgical stone management, with limited data on urine metabolic risk factors and the presence of stones after follow-up.
Methods
We retrospectively evaluated kidney transplant recipients who were diagnosed with transplant nephrolithiasis between 2009 and 2019. Computed tomography and ultrasound imaging were used to confirm stone presence.
Results
The incidence of allograft kidney stone formation was 0.86% of 6548 kidney transplant recipients. Of the 56 cases identified, 17 (30%) had a pretransplant history of nephrolithiasis. Only four (7%) patients received a known kidney stone at the time of allograft implantation. Of the 56 cases, 34 had a 24-h supersaturation study. The urine supersaturation study showed 32 patients (94%) had a urine citrate of <450 mg excreted in 24 h (median 124.5 mg/24 h, reference range >500 mg/24 h), along with 22 patients (61%) having a urine oxalate excretion of ≥30 mg in 24 h (median 34.4 mg/24 h, reference range <30 mg/24 h). Calcium oxalate composition was most common (91% with >1 supersaturation for calcium oxalate crystals), with normal median urine calcium levels (median urine calcium 103.5 mg/24 h, reference range <200 mg/24 h). After a 4-year follow-up, 50% (n = 28) required surgical intervention and 43 (77%) patients continued to have evidence of transplant nephrolithiasis on imaging.
Conclusions
This is the largest study of transplant nephrolithiasis confirming that hypocitraturia and hyperoxaluria were the most significant urine metabolic risk factors associated with allograft nephrolithiasis and that hyperoxaluria was the most prevalent driver for calcium oxalate stone composition. Our study is first to show low stone-free rates at the last follow-up and a significant proportion requiring surgical intervention.
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Affiliation(s)
- Erin Bolen
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - Karen Stern
- Department of Urology, Mayo Clinic, Mayo Clinic College of Medicine and Science, Scottsdale, AZ, USA
| | - Mitchell Humphreys
- Department of Urology, Mayo Clinic, Mayo Clinic College of Medicine and Science, Scottsdale, AZ, USA
| | - Alexandra Brady
- Department of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ, USA
| | - Todd Leavitt
- Department of Statistics, Mayo Clinic, Scottsdale, AZ, USA
| | - Nan Zhang
- Department of Statistics, Mayo Clinic, Scottsdale, AZ, USA
| | - Mira Keddis
- Department of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ, USA
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Gerber RC, Best SL, Hedican SP, Nakada SY. Flexible Ureteroscopy as the New Standard for the Management of Renal Transplant Urolithiasis <15 mm: A Single-Center Experience. J Endourol 2021; 35:1443-1447. [PMID: 33691495 DOI: 10.1089/end.2020.0473] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: To determine the safety and efficacy of flexible ureteroscopy in the treatment of transplant urolithiasis. Materials and Methods: We reviewed a single-center series of 2652 patients who underwent surgical treatment for nephrolithiasis at our institution from 2009 to the present day to identify all patients undergoing ureteroscopy for treatment of transplant lithiasis. Results: We identified 18 patients who underwent ureteroscopy for treatment of urolithiasis within the transplanted kidney or ureter. The majority of the procedures were performed using a retrograde approach with flexible ureteroscopy, with one patient undergoing antegrade ureteroscopy and two patients requiring semirigid ureteroscopy. Holmium:yttrium-aluminum-garnet laser lithotripsy was utilized in all but one case, which was performed using basket extraction. There were no intraoperative complications reported. Four patients had small stone fragments on postoperative imaging, three of which were observed. One patient required repeat ureteroscopy for persistent distal ureteral stone. Conclusion: Retrograde ureteroscopy is a feasible, safe, and effective intervention for the treatment of transplant lithiasis. Minimal intraoperative or postoperative complications were reported, and only one patient required additional intervention for residual stone burden.
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Affiliation(s)
- Rebecca C Gerber
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sara L Best
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sean P Hedican
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Stephen Y Nakada
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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10
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Bessede T, Branchereau J, Goujon A, Boissier R, Alezra E, Verhoest G, Culty T, Matillon X, Doerfler A, Tillou X, Sallusto F, Terrier N, Thuret R, Drouin S, Timsit MO. [Urinary stones in renal transplant recipients and donors: The French guidelines from CTAFU]. Prog Urol 2021; 31:57-62. [PMID: 33423749 DOI: 10.1016/j.purol.2020.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To define guidelines for the management of kidney stones in kidney transplant (KTx) donor or recipients. METHOD Following a systematic approach, a review of the literature (Medline) was conducted by the CTAFU to report kidney stone epidemiology, diagnosis and management in KTx donors and recipients with the corresponding level of evidence. RESULTS Prevalence of kidney stones in deceased donor is unknown but reaches 9.3% in living donors in industrialized countries. Except in Maastrich 2 donors, diagnosis is done on systematic pre-donation CT scan according to standard french procedure. No prospective study has compared therapeutic strategies available for the management of kidney stones in KTx donor: ureteroscopy or an extra corporeal lithotripsy in case of living donor prior to donation, ex vivo approach (pyelotomy or ureteroscopy), ureterocopy in the KTx recipient or surveillance. De novo kidney stones result from a lithogenesis process to be identified and treated in order to avoid recurrences. The context of solitary functional kidney renders the prevention of recurrence of great importance. Diagnosis is suspected when identification of a renal graft dysfunction, hematuria or urinary tract infection with renal pelvis dilatation. Stone size and location are determined by computed tomography. There are no prospective, controlled studies on kidney stone management in the KTx. The therapeutic strategies are similar to standard management in general population. CONCLUSION These French recommendations should contribute to improve kidney stones management in KTx donor and recipients.
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Affiliation(s)
- T Bessede
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, université Paris Saclay, hôpital de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - J Branchereau
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Nantes, 5, allée de l'Ile Gloriette, 44093 Nantes cedex 01, France
| | - A Goujon
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - R Boissier
- Service d'urologie et transplantation, université Aix-Marseille, hôpital de la Conception, 47, boulevard Baille, 13005 Marseille, France
| | - E Alezra
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - G Verhoest
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - T Culty
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - X Matillon
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - A Doerfler
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU Brugmann, place A. Van Gehuchten 4, 1020 Bruxelles, Belgique
| | - X Tillou
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - F Sallusto
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Toulouse, 9, place Lange, 31300 Toulouse, France
| | - N Terrier
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU Grenoble Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - R Thuret
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital Lapeyronie, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34070 Montpellier, France
| | - S Drouin
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, université Paris Sorbonne, hôpital de la Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - M-O Timsit
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Inserm, équipe labellisée par la ligue contre le cancer, université de Paris, PARCC, 56, rue Leblanc, 75015 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France.
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11
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Abt D. Steinleiden bei anatomischen Besonderheiten. Urolithiasis 2021. [DOI: 10.1007/978-3-662-62454-8_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Chaker H, Yaich S, Fendri B, Toumi S, Kammoun K, Mseddi MA, Hadj Slimen M, Ben Hmida M. [Urolithiasis of the kidney transplanted patient in south Tunisia: A 17-year experience]. Nephrol Ther 2020; 16:414-419. [PMID: 33203612 DOI: 10.1016/j.nephro.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/11/2020] [Accepted: 08/03/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Urolithiasis in a kidney transplanted patient is an uncommon but complex urological complication. Its potential severity comes from its occurrence on a solitary kidney and on a field of immunosuppression. The aim of our study is to assess the incidence, characteristics and course of urolithiasis in our series. METHODS A retrospective study was performed. We included kidney transplanted patients between November 2002 and November 2019 and presenting lithiasis during their follow-up. Clinical, biological and radiological data were collected as well as lithiasis disease related data. The management of and patient's evolution were also specified. RESULTS Seven of 416 kidney transplanted patients developed lithiasis during their follow-up with an incidence of 1.6 %. The mean age at lithiasis diagnosis was 36.5 years [24-55 years], the sex ratio was 1.3. They developed stones after mean follow-up of 67 months [4-168 months]. The stones' size varied from 2 to 18mm. Treatment was alkalisation in 3 cases, extracorporeal lithotripsy in 2 cases, a double J stent in 3 cases and pyelolithotomy in 2 cases. Four patients had multiple treatments. Three patients had 1 residual stone during evolution (7mm average diameter), 1 microlithiasis, 1 lost to follow-up after treatment and only 2 (out of 7) were "stone free". Furthermore, lithiasis didn't damage the graft survival after a median follow-up of 62 months post-treatment. CONCLUSION Urolithiasis in the kidney transplanted patient requires an adapted multidisciplinary management. Its skill is a challenge for both the nephrologist and urologist.
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Affiliation(s)
- Hanen Chaker
- Service de néphrologie, CHU Hedi-Chaker, Sfax, Tunisie, laboratoire de recherche de pathologie rénale LR19ES11, faculté de médecine, Sfax, Tunisie.
| | - Soumaya Yaich
- Service de néphrologie, CHU Hedi-Chaker, Sfax, Tunisie, laboratoire de recherche de pathologie rénale LR19ES11, faculté de médecine, Sfax, Tunisie
| | - Beya Fendri
- Service de néphrologie, CHU Hedi-Chaker, Sfax, Tunisie, laboratoire de recherche de pathologie rénale LR19ES11, faculté de médecine, Sfax, Tunisie
| | - Salma Toumi
- Service de néphrologie, CHU Hedi-Chaker, Sfax, Tunisie, laboratoire de recherche de pathologie rénale LR19ES11, faculté de médecine, Sfax, Tunisie
| | - Khawla Kammoun
- Service de néphrologie, CHU Hedi-Chaker, Sfax, Tunisie, laboratoire de recherche de pathologie rénale LR19ES11, faculté de médecine, Sfax, Tunisie
| | | | | | - Mohamed Ben Hmida
- Service de néphrologie, CHU Hedi-Chaker, Sfax, Tunisie, laboratoire de recherche de pathologie rénale LR19ES11, faculté de médecine, Sfax, Tunisie
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Branchereau J. Redefining the urologist's role in kidney transplantation. World J Urol 2020; 40:301-302. [PMID: 33175209 DOI: 10.1007/s00345-020-03520-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/30/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Julien Branchereau
- Department of Urology / Nantes University Hospital, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France.
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Li X, Li B, Meng Y, Yang L, Wu G, Jing H, Bi J, Zhang J. Treatment of recurrent renal transplant lithiasis: analysis of our experience and review of the relevant literature. BMC Nephrol 2020; 21:238. [PMID: 32576135 PMCID: PMC7310338 DOI: 10.1186/s12882-020-01896-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Renal transplant lithiasis is a rather unusual disease, and the recurrence of lithiasis presents a challenging situation. METHODS We retrospectively analyzed the medical history of one patient who suffered renal transplant lithiasis twice, reviewed the relevant literature, and summarized the characteristics of this disease. RESULTS We retrieved 29 relevant studies with an incidence of 0.34 to 3.26% for renal transplant lithiasis. The summarized incidence was 0.52%, and the recurrence rate was 0.082%. The mean interval after transplantation was 33.43 ± 56.70 mo. Most of the patients (28.90%) were asymptomatic. The management included percutaneous nephrolithotripsy (PCNL, 22.10%), ureteroscope (URS, 22.65%), extracorporeal shockwave lithotripsy (ESWL, 18.60%) and conservative treatment (17.13%). In our case, the patient suffered from renal transplant lithiasis at 6 years posttransplantation, and the lithiasis recurred 16 months later. He presented oliguria, infection or acute renal failure (ARF) during the two attacks but without pain. PCNL along with URS and holmium laser lithotripsy were performed. The patient recovered well after surgery, except for a 3 mm residual stone in the calyx after the second surgery. He had normal renal function without any symptoms and was discharged with oral anticalculus drugs and strict follow-up at the clinic. Fortunately, the calculus passed spontaneously about 1 month later. CONCLUSIONS Due to the lack of specific symptoms in the early stage, patients with renal transplant lithiasis may have delayed diagnosis and present ARF. Minimally invasive treatment is optimal, and the combined usage of two or more procedures is beneficial for patients. After surgery, taking anticalculus drugs, correcting metabolic disorders and avoiding UIT are key measures to prevent the recurrence of lithiasis.
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Affiliation(s)
- Xiaohang Li
- Department of Hepatobiliary Surgery, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Baifeng Li
- Department of Hepatobiliary Surgery, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Yiman Meng
- Department of Hepatobiliary Surgery, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Lei Yang
- Department of Hepatobiliary Surgery, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Gang Wu
- Department of Hepatobiliary Surgery, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Hongwei Jing
- Department of Urology, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Jianbin Bi
- Department of Urology, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Jialin Zhang
- Department of Hepatobiliary Surgery, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China.
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15
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Donor and post-transplant ureteroscopy for stone disease in patients with renal transplant. Curr Opin Urol 2019; 29:548-555. [DOI: 10.1097/mou.0000000000000618] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Over 30-yr Experience on the Management of Graft Stones After Renal Transplantation. Eur Urol Focus 2018; 4:169-174. [DOI: 10.1016/j.euf.2018.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/18/2018] [Accepted: 06/11/2018] [Indexed: 02/04/2023]
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