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Haberal HB, Tonyali S, Piana A, Keller EX, Sierra A, Bañuelos Marco B, Tzelves L, Pecoraro A, Esperto F, López-Abad A, Prudhomme T, Campi R, Boissier R, Pietropaolo A, Breda A, Territo A. Current Perspectives on Endourological Ex Vivo Stone Interventions in Kidney Transplantation: A Systematic Review. Urology 2024; 191:144-152. [PMID: 38878828 DOI: 10.1016/j.urology.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/01/2024] [Accepted: 06/04/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE To conduct a systematic review (SR) of literature to assess the existing evidence concerning the success and complications of endourological ex vivo stone surgeries. METHODS Eligible studies for inclusion focused on investigating the success and/or complications related to endourological ex vivo surgeries in donors with nephrolithiasis. A SR was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search included databases of Web of Science, PubMed, and Scopus and only article in English were included. Studies published between 2002 and 2023 included in this SR. RESULTS After screening 1726 abstracts, this SR included 16 studies with a total of 209 patients. The mean stone size was 5.6 mm and majority of kidneys contained single stones, located in the lower calyx. After ex vivo endourological stone surgeries, the average stone-free rate was found to be 95.4%. The mean duration of ex vivo surgery was 17.3 minutes. Regarding intraoperative complications, two patients (1%) experienced mucosal injuries during pneumatic lithotripsy. As for postoperative complications, two patients (1%) experienced vascular complications. In terms of urological complications, hematuria was observed in 24 patients (11.5%), while one patient (0.5%) experienced clot formation in renal pelvis. Seven patients (3.3%) had urinary tract infections, and three patients (1.4%) developed urolithiasis during the follow-up. Additionally, one patient (0.5%) experienced complete occlusion of ureteroneocystostomy and required revision. CONCLUSION Given the advancements in current technology and techniques, endourological ex vivo stone surgeries are increasingly recognized as an effective and safe option for donors with nephrolithiasis. TRIAL REGISTRATION This systematic review was registered under the protocol registration number CRD42024538384/PROSPERO.
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Affiliation(s)
- Hakan Bahadir Haberal
- Department of Urology, Ankara Ataturk Sanatoryum Training and Research Hospital, Ministry of Health, University of Health Sciences, Ankara, Turkey.
| | - Senol Tonyali
- Department of Urology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Alberto Piana
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alba Sierra
- Division of Kidney Transplant, Department of Urology, Hospital Clinic, Barcelona, Spain
| | - Beatriz Bañuelos Marco
- Department of Urology, Renal Transplant Division, University Hospital Clínico San Carlos, Madrid, Spain
| | - Lazaros Tzelves
- Institute of Urology, University College Hospital London, London, United Kingdom
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Esperto
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Alicia López-Abad
- Department of Urology, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Thomas Prudhomme
- Department of Urology and Kidney Transplantation, Rangueil University Hospital, Toulouse, France
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Romain Boissier
- Department of Urology & Renal Transplantation, La Conception University Hospital, Assistance-Publique, Marseille, France
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Alberto Breda
- Uro-oncology and Kidney Transplant Unit, Department of Urology at "Fundació Puigvert" Hospital, Autonoma University of Barcelona, Barcelona, Spain
| | - Angelo Territo
- Uro-oncology and Kidney Transplant Unit, Department of Urology at "Fundació Puigvert" Hospital, Autonoma University of Barcelona, Barcelona, Spain
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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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Takai S, Nishida H, Fukuhara H, Kurokawa M, Tsuchiya N. Ureteroureterostomy With Near-Infrared Ray Catheter in a Kidney Transplant. Cureus 2024; 16:e57687. [PMID: 38711694 PMCID: PMC11070896 DOI: 10.7759/cureus.57687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2024] [Indexed: 05/08/2024] Open
Abstract
Transplant ureteral stenosis (US) is a complication of kidney transplantation (KT) that sometimes adversely affects kidney function. Endoscopic treatment may be selected as the initial treatment; however, the recurrence rate is high. Ureteral reconstruction is necessary as a secondary treatment, but it is often difficult to identify the transplanted ureter due to reoperation; therefore, transplanted ureter and renal arteriovenous injury are intraoperative complications that should be noted. The Near-Infrared Ray Catheter (NIRC™) fluorescent ureteral catheter (NIRFUC) fluoresces by illuminating near-infrared rays, facilitating the identification of intraoperative ureteral locations. Herein, we report the case of a 34-year-old woman who developed US following KT. She underwent balloon dilation for transplant US, but the stenosis recurred; therefore, she underwent transplant ureteral auto-ureteral anastomosis. Although it was difficult to identify and detach the transplanted ureter owing to adhesions, the use of NIRFUC facilitated the identification of the ureter in the surgical field and enabled safe end-side anastomosis between the transplanted ureter and the autologous ureter. In conclusion, although there is no consensus on the best method for complex transplantation-related US cases, NIRFUC may be used to safely identify and perform surgeries on the ureter.
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Affiliation(s)
- Satoshi Takai
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, JPN
| | - Hayato Nishida
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, JPN
| | - Hiroki Fukuhara
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, JPN
| | - Masayuki Kurokawa
- Department of Urology, Jichi Medical University Faculty of Medicine, Shimotsuke, JPN
| | - Norihiko Tsuchiya
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, JPN
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Caamiña L, Pietropaolo A, Prudhomme T, Bañuelos B, Boissier R, Pecoraro A, Campi R, Dönmez MI, Sierra A, Piana A, Somani BK, Territo A. Endourological Management of Ureteral Stricture in Patients with Renal Transplant: A Systematic Review of Literature. J Endourol 2024; 38:290-300. [PMID: 38185833 DOI: 10.1089/end.2023.0478] [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: 01/09/2024] Open
Abstract
Purpose: To analyze the utility and outcomes of available endourologic options to treat ureteral stricture after kidney transplantation (KT). Methods: A systematic review was carried out for all English language articles from 2000 to 2023 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) standards using EMBASE, MEDLINE, SCOPUS, Google scholar, and Cochrane library. The search term combination for the string was follows: [(Ureteral stricture) OR (ureter stenosis) OR (ureteral stenosis) OR (Stricture ureter) OR (Narrowing ureter) OR (Ureter restriction) OR (ureteral restriction) OR (ureteral narrowing) OR (ureteral obstruction) OR (ureter obstruction) OR (obstructing ureter) OR (obstructive ureter) OR (narrow ureter) OR (ureteral narrow)] AND [(kidney transplant) OR (transplanted kidney) OR (transplant) OR (transplantation)] AND [(management) OR (Robotic) OR (laser) OR (stent) OR (dilatation) OR (dilation) OR (endoscopic) OR (endourological) OR (Urologic) OR (laparoscopic) OR (surgery) OR (treatment)]. Case reports, review articles, animal and laboratory studies were excluded. Risk of bias assessment was conducted using the RoB 2 and ROBINS-I tools. Results: A total of 1102 relevant articles published from 2000 to 2023 were found. After screening of titles and abstracts, a total of 19 articles were included in our systematic review. Ureteral stent/nephrostomy placement, balloon dilatation (ureteroplasty) with or without laser was used as initial approaches whereas follow-up and success rate were analyzed among other parameters. Conclusions: The management of ureteral strictures after KT is challenging and selecting the most appropriate treatment is crucial for successful outcomes. Our review suggests that, an endourologic management is a safe option with good long-term outcomes, especially in short and early strictures.
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Affiliation(s)
- Leticia Caamiña
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
| | - Thomas Prudhomme
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Beatriz Bañuelos
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Division Renal Transplantation and Reconstructive Urology, Hospital Universitario El Clínico San Carlos, Madrid, Spain
| | - Romain Boissier
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Department of Urology and Renal Transplantation, La Conception University Hospital, Marseille, France
| | - Alessio Pecoraro
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Riccardo Campi
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Muhammet Irfan Dönmez
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Alba Sierra
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Urology Department, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Alberto Piana
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Department of Urology, University of Turin, Turin, Italy
- Department of Urology, Romolo Hospital, Rocca di Neto, Italy
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Angelo Territo
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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