ENDOUROLOGICAL MANAGEMENT OF UROLITHIASIS IN TRANSPLANTED KIDNEYS

Abstract

ABSTRACT

Renal transplantation is now considered as the best and long-term treatment option for patients with end-stage renal disease. When kidney transplant recipient patient develop urolithiasis, it can be a challenge deciding how to treat these patients The early diagnosis of such condition is essential, as the patient is relying on a single kidney. Post-transplantation Urolithiasis can be easily managed with urological intervention.

Objectives: Evaluate Mode of Presentation , Diagnosis and Endourological approach to urolithiasis in post renal transplant

Methods : We reviewed a series of patients who underwent surgical treatment for post renal transplant urolithiasis at our institution from 1998 to 2018. Their mode of presentation, investigations, treatments, complications and outcomes were recorded. Investigations included one or more of the following; ultrasonography (US), plain abdominal X-ray, intravenous urography and computed tomography. Various methods include URS , RIRS , PCNL , Lap assisted PCNL , combined Laparoscopic and RIRS approach – ECIRS

Results : We treated 21 patients who underwent a form of endourological treatment of urolithiasis after renal transplant. Mode of presentation was asymptomatic -13 patients, 3 patient with anuria, one patient each haematuria ,ARF , pain at graft site and 2 patients with UTI/fever. Initially diagnosed with ultrasound and CT scan was used to plan management. Of the various locations found on investigations 5- multiple calculi in calyx ,10 renal pelvic calculi , 2 partial stag-horn calculi ,3 ureteric calculi, 1 bladder calculi. Treatment included RIRS -2 ,URS 1, PCNL 2 , Lap assisted PCNL 7 , Combined Lap assisted PCNL and RIRS-ECIRS 4 and cystolithotrity 1. Energy modalities user were Ho-laser ,combination of ultrasound and pneumatic lithotripsy (Lithoclast Master) and ultrasonic energy (Shock Pulse).There were no intraoperative complications reported. 2 patients had small stone fragments on postoperative imaging. All patients were stone-free on followed up after 6 weeks.

Conclusion  Endourological techniques are feasible, safe, and effective modality for the treatment of transplant lithiasis with Minimal intraoperative or postoperative complications and with a good stone clearance rates.