Palazzo Silvano, Colamonico Ottavio, Forte Saverio, Matera Matteo, Lucarelli Giuseppe, Ditonno Pasquale, Battaglia Michele, Martino Pasquale
Department of Emergency and Organ Transplantation, University of Bari.
Arch Ital Urol Androl. 2016 Dec 30;88(4):337-340. doi: 10.4081/aiua.2016.4.337.
Urolithiasis of the transplanted kidney has an incidence of 0.2 to 1.7%, it increases the risk of infection in immunosuppressed patients and it can lead to ureteral obstruction that is often associated with deterioration of renal function. Urolithiasis of the transplanted kidney has different characteristics compared to the native kidney, due to the absence of innervation, which does not lead to colic pain. Percutaneous approach is an optimal choice in transplant patients.
Here we report our experience in two cadaveric transplant patients with urolithiasis. The first case was a patient of 68 years with a 20 mm stone located in the transplanted kidney pelvis and another smaller in a lower calyx. The second case was a patient of 65 years with a 15 mm stone in the distal part of the transplanted ureter. In both cases the patients were asymptomatic, but they had a reduction in urine output associated with worsening of the transplanted kidney function. The diagnosis was performed in both cases with ultrasound study, showing a severe hydronephrosis and it was confirmed by computed tomography scan. In both cases, we performed a Percutaneous Nephrolithotomy (PCNL). Access was made after targeting the stone, through a lower pole puncture under ultrasound guidance. The first case was treated with pneumatic and laser energy, breaking stones through a nephroscope. In the second case we performed a laser lithotripsy of the ureteral stone, using a flexible videoureteroscope. At the end of both procedures a Double-J stent and a 14 Fr Malecot nephrostomy were positioned, that were removed at 6 weeks and 10 days, respectively.
Both patients achieved a resolution of the worsening of renal function, recovering the spontaneous diuresis. The surgical procedure using ultrasound guidance was safe and allowed quick access to the renal pelvis. Both patients experienced no bleeding or infection during hospitalization.
Percutaneous Nephrolithotomy (PCNL) is an established safe and effective surgical treatment option for larger renal calculi in renal allografts. The ultrasound guided access to the transplanted kidney in percutaneous treatment of urolithiasis is useful and fast, minimizing patient exposure to ionizing radiation.
移植肾尿路结石的发病率为0.2%至1.7%，它增加了免疫抑制患者感染的风险，并可导致输尿管梗阻，而这往往与肾功能恶化相关。与天然肾相比，移植肾尿路结石具有不同的特征，因为缺乏神经支配，不会导致绞痛。经皮治疗方法是移植患者的最佳选择。
在此，我们报告两例尸体肾移植患者尿路结石的治疗经验。第一例患者为68岁，移植肾盂内有一枚20毫米的结石，下盏还有一枚较小的结石。第二例患者为65岁，移植输尿管远端有一枚15毫米的结石。两例患者均无症状，但尿量减少，移植肾功能恶化。两例均通过超声检查进行诊断，显示重度肾积水，并经计算机断层扫描证实。两例均行经皮肾镜取石术（PCNL）。在超声引导下，经下极穿刺靶向结石后建立通道。第一例采用气压弹道和激光能量，通过肾镜碎石。第二例使用可弯曲电子输尿管镜对输尿管结石进行激光碎石术。两个手术结束时均放置双J管和14F麦氏肾造瘘管，分别于6周和10天后拔除。
两例患者肾功能恶化均得到缓解，恢复了自主利尿。超声引导下的手术操作安全，能快速进入肾盂。两例患者住院期间均未发生出血或感染。
经皮肾镜取石术（PCNL）是治疗同种异体移植肾较大肾结石的一种安全有效的既定手术治疗选择。在经皮治疗尿路结石时，超声引导进入移植肾有用且快速，可将患者暴露于电离辐射的风险降至最低。
