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Cerrato C. et al., 2023: Shockwave Lithotripsy for De-Novo Urolithiasis after Kidney Transplantation: A Systematic Review of the Literature

Cerrato C, Jahrreiss V, Nedbal C, Ripa F, De Marco V, Monga M, Pietropaolo A, Somani B.
Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK.
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, 1090 Vienna, Austria.
Urology Unit, School of Urology, Faculty of Medicine, Università Politecnica delle Marche, 60121 Ancona, Italy.
Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, 20122 Milan, Italy.
Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, 37126 Verona, Italy.
Department of Urology, University of California San Diego, San Diego, CA 92037, USA.
European Association of Urology-Young Academic Urologists (EAU-YAU), Urolithiasis and Endourology Working Group, NL-6803 AA Arnhem, The Netherlands.

 Abstract

Background: Allograft urolithiasis is an uncommon, challenging, and potentially dangerous clinical problem. Treatment of allograft stones includes external shockwave lithotripsy (SWL), flexible ureteroscopy and lasertripsy (fURSL), or percutaneous nephrolithotomy (PCNL). A gap in the literature and guidelines exists regarding the treatment of patients in this setting. The aim of this systematic review was to collect preoperative and treatment characteristics and evaluate the outcomes of post-transplant SWL for stone disease.

Methods: A systematic search in the literature was performed, including articles up to March 2023. Only original English articles were selected.

Results: Eight articles (81 patients) were included in the review. Patients were mainly male, with a mean age of 41.9 years (±7.07). The mean stone size was 13.18 mm (±2.28 mm). Stones were predominantly located in the kidney (n = 18, 62%). The overall stone-free rate and complication rates were 81% (range: 50-100%) and 17.2% (14/81), respectively, with only one major complication reported. A pre-operative drainage was placed in eleven (13.5%) patients. Five patients (6.71%) required a second treatment for residual fragments.

Conclusions: SWL is a safe and effective option to treat de novo stones after transplantation. Larger studies are needed to better address allograft urolithiasis management.

J Clin Med. 2023 Jun 29;12(13):4389. doi: 10.3390/jcm12134389. PMID: 37445423 
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Comments 1

Hans-Göran Tiselius on Wednesday, 07 February 2024 10:00

This article is a report on SWL treatment of stones in transplanted kidneys and in that regard, it is valuable reading for all urologists who might encounter this clinical condition. It is of note that most patients with renal/ureteral stones in transplanted kidneys are asymptomatic or suffering from very mild or vague symptoms.
The outcome of this systematic review of the literature based on 8 publications comprising 81 patients showed a stone-free rate of 81% with complications that usually were mild in 17%.

The bottom-line is that SWL is an excellent method for treating patients with stones in transplanted kidneys. It is emphasized that URS in these patients might be technically difficult. I agree with that view.

Important rules and recommendations taken from the article:
Carry out SWL as soon as possible after diagnosis.

Apply SWL with the patients in prone position with a waterbag to create a transmission zone of sufficient size.

Administer shock waves with low energy (low voltage) and low frequency.
Uric acid stones are best treated medically!

Although α-receptor antagonists were used in only one study, this treatment is worthwhile to consider.

Finally, these patients preferably should be treated at a center with sufficient experience and ideally in a hospital with transplantation experience.

This article is recommended for reading by urologists who commonly treat patients with stone disease.

Hans-Göran Tiselius

This article is a report on SWL treatment of stones in transplanted kidneys and in that regard, it is valuable reading for all urologists who might encounter this clinical condition. It is of note that most patients with renal/ureteral stones in transplanted kidneys are asymptomatic or suffering from very mild or vague symptoms. The outcome of this systematic review of the literature based on 8 publications comprising 81 patients showed a stone-free rate of 81% with complications that usually were mild in 17%. The bottom-line is that SWL is an excellent method for treating patients with stones in transplanted kidneys. It is emphasized that URS in these patients might be technically difficult. I agree with that view. Important rules and recommendations taken from the article: Carry out SWL as soon as possible after diagnosis. Apply SWL with the patients in prone position with a waterbag to create a transmission zone of sufficient size. Administer shock waves with low energy (low voltage) and low frequency. Uric acid stones are best treated medically! Although α-receptor antagonists were used in only one study, this treatment is worthwhile to consider. Finally, these patients preferably should be treated at a center with sufficient experience and ideally in a hospital with transplantation experience. This article is recommended for reading by urologists who commonly treat patients with stone disease. Hans-Göran Tiselius
Monday, 20 May 2024