Mahdavi Reza, Tavakkoli Mahmoud, Taghavi Rahim, Ghoreifi Alireza
Division of Urology, Mashhad University of Medical Sciences, Mashhad, Iran.
Exp Clin Transplant. 2014 Jun;12(3):200-4.
To assess the safety and efficacy of minimally invasive procedures for urolithiasis in transplanted kidneys.
A retrospective study was done on kidney transplant patients who had urolithiasis treated with minimally invasive procedures between January 1989 and September 2011. We evaluated patient characteristics, predisposing factors, clinical presentation, minimally invasive procedures used, frequency of success, and complications.
In 1800 kidney transplants, 21 recipients developed urolithiasis (mean age, 31 y; 13 men and 8 women) and were treated with minimally invasive procedures. Predisposing factors included hyperparathyroidism (6 patients), hyperuricemia (5 patients), recurrent urinary tract infection (4 patients), ureteral stricture or obstruction (2 patients), and unknown factors (4 patients). Clinical presentation included hematuria (5 patients), azotemia (4 patients), anuria (3 patients), urinary tract infection (3 patients), and hydronephrosis (2 patients). The stones were located in the kidney (11 patients) or ureter (10 patients). Mean stone size was 11 ± 3 mm (range, 6-18 mm). Depending on the size and location of stones, treatment included extracorporeal shock wave lithotripsy in 10 patients, transurethral lithotripsy in 9 patients, and percutaneous nephrolithotomy in 2 patients. Stone-free status was achieved in 7 of 10 patients who were treated with shock wave lithotripsy (70%), 8 of 9 patients who were treated with transurethral lithotripsy (89%), and 2 of 2 patients who were treated with percutaneous nephrolithotomy (100%). All 4 patients who did not become stone-free after initial treatment (3 patients after shock wave lithotripsy and 1 patient after transurethral lithotripsy) became stone-free after secondary treatment with percutaneous nephrolithotomy (100%). No intraoperative complications occurred.
Minimally invasive procedures (mono-therapy or combination therapy) for urolithiasis in transplanted kidneys are safe and effective, and high overall stone-free results may be achieved.
评估移植肾尿路结石微创治疗的安全性和有效性。
对1989年1月至2011年9月期间接受微创治疗尿路结石的肾移植患者进行回顾性研究。我们评估了患者特征、诱发因素、临床表现、所采用的微创治疗方法、成功率及并发症。
在1800例肾移植中，21例受者发生尿路结石（平均年龄31岁；男性13例，女性8例）并接受了微创治疗。诱发因素包括甲状旁腺功能亢进（6例患者）、高尿酸血症（5例患者）、复发性尿路感染（4例患者）、输尿管狭窄或梗阻（2例患者）以及不明因素（4例患者）。临床表现包括血尿（5例患者）、氮质血症（4例患者）、无尿（3例患者）、尿路感染（3例患者）及肾积水（2例患者）。结石位于肾脏（11例患者）或输尿管（10例患者）。结石平均大小为11±3mm（范围6 - 18mm）。根据结石大小和位置，10例患者接受体外冲击波碎石术，9例患者接受经尿道碎石术，2例患者接受经皮肾镜取石术。接受冲击波碎石术的10例患者中有7例（70%）结石清除，接受经尿道碎石术的9例患者中有8例（89%）结石清除，接受经皮肾镜取石术的2例患者均结石清除（100%）。初始治疗后未实现结石清除的4例患者（冲击波碎石术后3例，经尿道碎石术后1例）在接受经皮肾镜取石术二次治疗后均实现结石清除（100%）。未发生术中并发症。
移植肾尿路结石的微创治疗（单一疗法或联合疗法）安全有效，总体结石清除率较高。
