Pushkar Praveen, Agarwal Anshuman, Kumar Surjeet, Guleria Sandeep
, New Delhi, Delhi, India,
Int Urol Nephrol. 2015 Jul;47(7):1123-7. doi: 10.1007/s11255-015-1007-z. Epub 2015 May 19.
Live related renal donors with urolithiasis are made suitable for renal transplantation in two-stage procedure in most of the centers: first making the donor kidney stone free surgically or by ESWL and then proceeding to renal transplantation. To reduce the cost and morbidity of two surgical procedures in donors, we did a pilot study of removing subcentimeter renal calculi in live donors, after explanting the kidney, during bench surgery.
We included all prospective renal donors with subcentimeter (4-10 mm) calculi in one kidney in our study (n = 14). All these patients underwent standard donor evaluation and metabolic work up. After the donor nephrectomy, bench retrograde intra-renal surgery (RIRS) with or without pyelotomy was done for stone clearance followed by renal transplantation.
Stone clearance was achieved in 13 out of 14 donors. Donors and recipients were followed for 6-24 months. No stone recurrence or graft dysfunction was seen in the follow-up period.
We concluded that bench RIRS is an excellent modality in the management of small renal calculi in prospective renal donors who are not having metabolically active disease. This reduced the cost and morbidity to the donor and minimized waiting time for transplant.
在大多数中心,患有尿路结石的活体亲属肾供体需通过两阶段手术来适合肾移植:首先通过手术或体外冲击波碎石术(ESWL)使供体肾脏无结石,然后进行肾移植。为降低供体两次手术的成本和发病率,我们进行了一项初步研究,即在离体肾脏的情况下,在体外手术期间为活体供体清除小于1厘米的肾结石。
我们的研究纳入了所有一侧肾脏有小于1厘米(4 - 10毫米)结石的前瞻性肾供体(n = 14)。所有这些患者均接受了标准的供体评估和代谢检查。在供体肾切除术后,进行有或无肾盂切开术的体外逆行肾内手术(RIRS)以清除结石,随后进行肾移植。
14名供体中有13名实现了结石清除。对供体和受体进行了6至24个月的随访。随访期间未发现结石复发或移植物功能障碍。
我们得出结论,体外RIRS是管理无代谢活跃疾病的前瞻性肾供体中小肾结石的一种极佳方式。这降低了供体的成本和发病率,并将移植等待时间降至最短。