Mp04-19 Endourological Management of Urolithiasis in Transplanted Kidneys

You have accessJournal of UrologyStone Disease: Surgical Therapy (including ESWL) I (MP04)1 May 2024MP04-19 ENDOUROLOGICAL MANAGEMENT OF UROLITHIASIS IN TRANSPLANTED KIDNEYS Parth Mahesh Manek, Vaibhav Vinkare, Prashant Pattnaik, and Umesh Oza Parth Mahesh ManekParth Mahesh Manek , Vaibhav VinkareVaibhav Vinkare , Prashant PattnaikPrashant Pattnaik , and Umesh OzaUmesh Oza View All Author Informationhttps://doi.org/10.1097/01.JU.0001008708.00982.a9.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Renal transplant is the most effective treatment for ESRD1. Incidence of urolithiasis in transplanted kidney - 0.2 to 6.3 %2. Urolithiasis in transplanted kidney do not present with classic colic, rather present with hematuria, AKI , Oligouria or repeated UTI. Hence they are clinically difficult to diagnose with risk of significant morbidity3. Endourological techniques have replaced open surgery. We examined the efficacy and safety of endourological procedures used to manage cases of Urolithiasis in a cohort of renal transplant recipients treated at our center. METHODS: Our Study is a retrospective analysis of patients with post transplant urolithiasis who were referred to our center , from January 1998 to December 2018 . We identified 21 patients fitting in to our criteria, of which 15 were males and 6 were females. Mean age was 39.5 years. Mean interval from transplant to diagnosis of urolithiasis was 2.5 years. The most common clinical presentation was painless hematuria in 7 patients , of which 5 were microscopic and 2 were gross. Rising creatinine was found on routine follow up of 6 patients. 3 patients had vague lower abdominal pain. 2 patients had repeated UTI. 1 patient with sudden oligouria. USG (Abdomen+pelvis) was the most commonly done initial investigation and NCCT was done in 18 patients preoperatively for surgical planning. Mean stone size was 1.9 cm , ranging from 0.8 cm to 4.2cm. RESULTS: Most common location of calculi was renal pelvis in 10 patients followed by calyces in 5, Ureter in 3, and 1 in bladder. Lap-guided PCNL was performed in 8 cases , with complete clearance in all cases. Percutaneous approaches like PCNL, lap-guided PCNL and ECIRS have a better clearance for a larger stone burden. All PCNL approaches were performed in a supine position , with a leg split during ECIRS. However, there were certain challenges associated with transplanted allografts like -dense post inflammatory capsule made puncture and dilatation of tract difficult, not all allografts were placed in the same position. RIRS was done in 5 cases , 3 upper calyx and 2 upper ureteric calculi. Complete clearance was achieved in all cases using holmium laser. Key here is to 1st identify neo ureteric orifice and negotiate wire into tortuous ureter. 2 procedues had to be staged (ECIRS and PCNL) CONCLUSIONS: Transplant urolithiasis requires nephrologists and urologists to maintain vigilance and a high index of suspicion. Using endourological procedures, alone or in combination is beneficial to improve efficiency. We recommend that such patients be managed in specialist centers with well equipped endourological armamentarium. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e42 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Parth Mahesh Manek More articles by this author Vaibhav Vinkare More articles by this author Prashant Pattnaik More articles by this author Umesh Oza More articles by this author Expand All Advertisement PDF downloadLoading ...