Ganpule A, Vyas JB, Sheladiya C, Mishra S, Ganpule SA, Sabnis RB, Desai M
Muljibhai Patel Urological Hospital, Department of Urology, Nadiad, Gujarat, India

Abstract

OBJECTIVE: To analyze our experience in management of urolithiasis in renal donors.

MATERIAL AND METHODS: The stones were treated either pretransplant or post transplant. The Amsterdam forum criteria for acceptance of living donors were used for donor selection. The donors underwent the following procedures, pretransplant extracorporeal shock wave lithotripsy (ESWL) (n=5). Pretransplant retrograde intrarenal surgery (RIRS) (n=1). Ex vivo ureteroscopy (Ex vivoURS) (n=1) and Ex vivo pyelolthotomy (Ex vivo Pyl) (n=2) and intraopertaive DJS and observation (n=3). Data was analyzed for technical feasibility intraoperative, postoperative complications and stone clearance.

RESULTS: The male: female ratio was 4:8 and average age was 52.3 years (38-71). In the pretransplant ESWL group average of 740 shocks (600-1500) were given, the power was not ramped up beyond 12 Kv. Ex vivo URS was performed on bench with 6F pediatric cystoscope, while in the Ex Vivo Pyl , a 12F nephroscope was introduced via a pyelotomy, stones were retrieved intact with a dormia basket.. A postoperative ultrasound at one month revealed complete clearance of stones in all except one donor. At a mean follow up of 36 months (10-58) there was no stone recurrence in donor or recipient.

CONCLUSIONS: This report shows the feasibility and safety of Ex vivo URS and Ex vivo PYL in living donors, in select cases with subcentimeter calculi, an option of conservative management with DJ stent is safe. ESWL/RIRS can be performed safely in the pre transplant setting. Proper donor selection and follow up is crucial to success. We propose a treatment selection algorithm for management of these donors.

J Endourol. 2012 Sep 13. [Epub ahead of print]
PMID:22973987 [PubMed - as supplied by publisher]