Li SD et al, 2011: Treatment of urinary lithiasis following kidney transplantation with extracorporeal shock-wave lithotripsy
Li SD, Wang QT, Chen WG
Department of Urology, General Hospital of Chengdu Military Command, Chengdu, Sichuan 610083, China
BACKGROUND: The incidence of urinary lithiasis following kidney transplantation is very low, and decision-supporting data are not available. The aim of this study was to review the diagnosis and treatment of urinary lithiasis following kidney transplantation, which is of realistic significance to reduce urinary lithiasis following kidney transplantation, prolong the survival of renal allografts.
METHODS: The incidence, diagnosis and treatment of urinary lithiasis in ten patients following kidney transplantation were analyzed retrospectively. Seven out of these patients had stones sized approximately 0.4 - 1.1 cm, and they were treated with low-voltage, low-frequency extracorporeal shock-wave lithotripsy (ESWL). Two patients had stones sized < 0.3 cm and they underwent cystoscopy and ureteroscopy. The ureteral catheter endoscopes were inserted in a retrograde manner to mobilize stones repeatedly. After elimination of obstruction, a ureteral double J stent was indwelt. One patient had a pelvic stone (1.2 cm), which was removed surgically.
RESULTS: The major clinical manifestations were hematuria, oliguria or anuria. Some patients were asymptomatic and they were diagnosed through laboratory tests and imaging examinations, e.g., ultrasonography. After elimination of obstruction, subjective symptoms disappeared in all patients, and the function of renal allografts recovered. A six-month follow-up indicated no remnant stones or lithiasis relapse.
CONCLUSIONS: The diagnosis and treatment of renal allograft lithiasis are challenging. After prompt and appropriate treatment, the prognosis was satisfactory, and permanent renal functional impairment did not occur in most patients.
Chin Med J (Engl). 2011 May;124(9):1431-4
PMID: 21740759 [PubMed - in process]
I was not aware of the fact that kidney transplant patients have no colic because the kidney and ureter are denervated. This can cause problems to establish the proper diagnosis.
10 stones in transplanted kidneys were treated by SWL (7) or ureteroscopy ( 2). The authors fail to explain why a 1,2 cm stone as removed surgically.