Category: Clinical Stones: PCNL

MP7-11 - Percutaneous nephrolithotomy in transplant patients

Fri, Sep 21
10:00 AM - 12:00 PM

Introduction & Objective : Lithiasic pathology appears in  0.2 to 1.7% of transplant patients. Within its treatment, percutaneous surgery appears as an alternative.The aim of our study is to review our serie of percutaneous nephrolithotomies (NLP) performed on renal grafts.


Methods : A retrospective observational study of the NLP performed in 2753 transplant patients from January 1980 to January 2017 was carried out. Surgical and postoperative data were collected.


Results : Eight patients, with an average of 53 years old, required percutaneous surgery 80 months after the transplant because of lithiasis.In the diagnosis, 2 patients presented acute renal failure, 6 hydronephrosis detected due to ultrasound and 5 required nephrostomy prior to the intervention.The surgery was performed in supine position. Access was obtained with ultrasound in 5 cases, one with fluoroscopy and two using the pre-existing nephrostomy. The dilatation was done with Alken or Amplatz except one case that was done with balloon; up to 24 Ch mostly.A nephroscope was used alone or in combination with a flexible ureteroscope in an antegrade manner in cases of ureteral lithiasis. The average size of the lithiasis was 16 mm (10 to 30 mm).The energy used in 5 cases was LASER Holmium and lithoclast in all the rest.All were left with nephrostomy except one with a ureteral catheter.We observed as a complication in a single patient renal bleeding (Clavien-Dindo IIIa) that required embolization. The mean hospitalization time was 14 days (4 to 26 days).Three patients had residual lithiasis on the control ultrasound. One of them received extracorporeal lithotripsy with good response and another underwent a second NLP with complete removal of the lithiasis 35 months after the first intervention.The average follow-up was 55 months.

 


Conclusions : Graft lithiasis can present as a silent pathology, that’s why the control ultrasound in transplant patients is necessary to make a proper diagnosis. Percutaneous surgery is safe and effective in the treatment of lithiasis in this group of patients. This surgery can be a complex procedure in a solitary kidney or in patients with a difficult urinary tract, which is why an adequate experience of the surgeon is necessary.

Cristina C. Ferreiro

Resident
Hospital Universitario de Bellvitge
Hospitalet de Llobregat, Catalonia, Spain

Carlos Torrecilla

Urologist
Lithiasis Unit, Hospital Universitari de Bellvitge
Barcelona, Catalonia, Spain

Luis Riera

Hospitalet de Llobregat, Catalonia, Spain

Jaime Fernández-Concha

Urology resident
Lithiasis Unit, Hospital Universitari de Bellvitge
Barcelona, Catalonia, Spain

I was born the 9th of October of 1986 in Lima, Perú. I decided upon medicine as a career towards the end of highschool and studied in Lima. After I graduated as a physician there, I applied for the Urology Residency in Spain and got into one of the best hospitals in Barcelona. Now I'm a 5th year resident with a soft spot for Lithiasis.

Sergi Colom

Hospitalet de Llobregat, Catalonia, Spain

Francesc Vigués

Hospitalet de Llobregat, Catalonia, Spain