Yagisawa Takafumi, Shimizu Tomokazu, Tachiki Ayane, Ishiyama Yudai, Onohara Tadashi, Iida Shoichi, Ishida Hideki, Takagi Toshio
Department of Urology and Kidney Transplantation Toda Chuo General Hospital Saitama Japan.
Department of Urology Tokyo Women's Medical University Tokyo Japan.
IJU Case Rep. 2024 Oct 13;8(1):32-35. doi: 10.1002/iju5.12800. eCollection 2025 Jan.
The management of urinary tract stones, particularly kidney allograft stones, presents unique challenges for kidney transplant recipients because of their prevalence and specific clinical considerations. Here, we describe a case in which percutaneous nephrolithotomy was successfully used to fragment a large kidney allograft stone ≥20 mm in size.
A 57-year-old woman who underwent ureteroureterostomy post simultaneous pancreas-kidney transplantation presented with gross hematuria after 15 years. Computed tomography revealed a 23-mm stone in the transplanted kidney. Initial attempts at endoscopic combined intrarenal surgery were changed to percutaneous nephrolithotomy because of poor ureter mobility and tortuosity. Stone fragmentation was achieved using pneumatic and ultrasonic lithotripsy. A second procedure using Swiss LithoClast Trilogy enabled complete stone clearance and ureteral stent placement.
By understanding the peculiarities of the percutaneous approach, we demonstrated the safe and effective use of a pneumatic and ultrasonic lithotripter for kidney allograft stone fragmentation.
尿路结石的治疗，尤其是肾移植结石，因其患病率和特殊的临床考虑因素，给肾移植受者带来了独特的挑战。在此，我们描述一例成功采用经皮肾镜取石术粉碎一枚直径≥20毫米的巨大肾移植结石的病例。
一名57岁女性，在接受胰肾联合移植术后行输尿管输尿管吻合术，15年后出现肉眼血尿。计算机断层扫描显示移植肾中有一枚23毫米的结石。由于输尿管活动度差且迂曲，最初的内镜联合肾内手术尝试改为经皮肾镜取石术。使用气动和超声碎石术实现了结石粉碎。第二次手术使用瑞士LithoClast Trilogy设备实现了结石完全清除并放置了输尿管支架。
通过了解经皮治疗方法的特点，我们证明了气动和超声碎石器在肾移植结石粉碎中的安全有效应用。
