Branchereau J et al, 2017: Management of renal transplant urolithiasis: a multicentre study by the French Urology Association Transplantation Committee.
Branchereau J, Timsit MO, Neuzillet Y, Bessède T, Thuret R, Gigante M, Tillou X, Codas R, Boutin J, Doerfler A, Sallusto F, Culty T, Delaporte V, Brichart N, Barrou B, Salomon L, Karam G, Rigaud J, Badet L, Kleinklauss F.
French Urology Association Transplantation Committee, Paris, France.
Department of Urology, CHU Nantes Hôtel Dieu, 1 Place Alexis Ricordeau, 44000, Nantes, France.
Abstract
PURPOSE: Urolithiasis is rare among renal transplant recipients and its management has not been clearly defined.
METHODS: This multicentre retrospective study was organised by the Comité de Transplantation de l'Association Française d'Urologie (French Urology Association transplantation committee). Statistical analysis was performed with SPSS 19 software.
RESULTS: Ninety-five patients were included in this study. Renal transplant urolithiasis was an incidental finding in 55% of cases, mostly on a routine follow-up ultrasound examination. One half of symptomatic stones were due to urinary tract infection and the other half were due to an episode of acute renal failure. The initial management following diagnosis of urolithiasis was double J stenting (27%), nephrostomy tube placement (21%), or watchful waiting (52%). Definitive management consisted of: watchful waiting (48%), extracorporeal lithotripsy (13%), rigid or flexible ureteroscopy (26%), percutaneous nephrolithotomy (11%) and surgical pyelotomy (2%). All transplants remained functional following treatment of the stone. The main limitation is the retrospective design. CONCLUSIONS: The incidence of lithiasis could be higher in kidney transplanted patients due to a possible anatomical or metabolical abnormalities. The therapeutic management of renal transplant urolithiasis appears to be comparable to that of native kidney urolithiasis.
World J Urol. 2017 Oct 22. doi: 10.1007/s00345-017-2103-8. [Epub ahead of print]
Comments 1
Stones in transplanted kidneys are problematic in several ways. The denervated kidney does not signal stone problems by pain. The different metabolic consequences of pharmacological treatment associated with graft control as well as other metabolic abnormalities need to be considered. Finally when stones have been detected the question is how to treat the patient. This article summarized the experience in 95 patients treated for stones in 11 transplantation centres (interesting information extracted below).
SWL was carried out by administration of shockwaves trans-abdominally.
Lessons learnt:
a. It is important to allow for a reasonable follow-up with US, measurement of renal function and identification of bacteriuria.
b. Identify and treat metabolic abnormalities
c. Apply careful selection of method for stone removal
It should be noted that with the exception of pyelolithotomy there was no absolute SFR whichever method that was used.