Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4710-057 Braga, Portugal.
Int Urol Nephrol. 2011 Jun;43(2):329-35. doi: 10.1007/s11255-010-9837-1. Epub 2010 Sep 17.
The purpose of this report is to assess the safety and efficacy of percutaneous nephrolithotomies (PNL) in transplanted kidneys.
Patient characteristics, predisposing factors, clinical presentation, surgical details, complications and outcomes were analyzed.
Between April 2002 and August 2009, seven patients (average 44 years old, 4 women and 3 men) were treated. Predisposing factors included hyperuricemia, hyperparathyroidism, recurrent urinary tract infection (n = 2 each) and retained double-J ureteral stent (n = 1). Clinical presentation consisted of urinary tract infection alone (n = 3) or in association with impaired renal function (n = 2) but also hematuria (n = 1) or impaired renal function (n = 1). Patients were treated in supine position, and calyx puncture was guided by the combination of ultrasound and fluoroscopy. Combined ultrasound and pneumatic lithotripsy (n = 5) or extraction (n = 2) was performed. Overall average stone size was 32.8 mm (range 20-50). Mean operative time was 102 min (range 75-150). Stone-free status was achieved in 6 patients (85.7%). No intraoperative complications occurred, including major bleeding. Mean initial and postoperative serum creatinine levels were 2.04 and 1.59, respectively. Average admission time was 6.9 days (range 4-9).
PNL of transplanted kidneys is a safe and effective method associated with a high overall stone-free rate. This approach should be considered in centers where expertise is available.
本报告旨在评估经皮肾镜取石术（PNL）在移植肾中的安全性和有效性。
分析了患者的特征、易患因素、临床表现、手术细节、并发症和结果。
2002 年 4 月至 2009 年 8 月期间，共治疗了 7 名患者（平均年龄 44 岁，4 名女性，3 名男性）。易患因素包括高尿酸血症、甲状旁腺功能亢进、复发性尿路感染（各 2 例）和留置双 J 输尿管支架（1 例）。临床表现为单纯尿路感染（3 例）或合并肾功能不全（2 例），但也有血尿（1 例）或肾功能不全（1 例）。患者取仰卧位，通过超声和透视相结合引导肾盏穿刺。采用联合超声和气压弹道碎石（5 例）或取石（2 例）。总体平均结石大小为 32.8mm（范围 20-50）。平均手术时间为 102 分钟（范围 75-150）。6 例患者（85.7%）达到结石清除状态。无术中并发症，包括大出血。初始和术后平均血清肌酐水平分别为 2.04 和 1.59。平均住院时间为 6.9 天（范围 4-9）。
移植肾的 PNL 是一种安全有效的方法，结石清除率总体较高。在有专业知识的中心，应考虑采用这种方法。
