Minimally invasive procedures for treatment of urolithiasis in transplanted kidneys.

Objectives: To assess the safety and efficacy of minimally invasive procedures for urolithiasis in transplanted kidneys.

Materials And Methods: A retrospective study was done on kidney transplant patients who had urolithiasis treated with minimally invasive procedures between January 1989 and September 2011. We evaluated patient characteristics, predisposing factors, clinical presentation, minimally invasive procedures used, frequency of success, and complications.

Results: In 1800 kidney transplants, 21 recipients developed urolithiasis (mean age, 31 y; 13 men and 8 women) and were treated with minimally invasive procedures. Predisposing factors included hyperparathyroidism (6 patients), hyperuricemia (5 patients), recurrent urinary tract infection (4 patients), ureteral stricture or obstruction (2 patients), and unknown factors (4 patients). Clinical presentation included hematuria (5 patients), azotemia (4 patients), anuria (3 patients), urinary tract infection (3 patients), and hydronephrosis (2 patients). The stones were located in the kidney (11 patients) or ureter (10 patients). Mean stone size was 11 ± 3 mm (range, 6-18 mm). Depending on the size and location of stones, treatment included extracorporeal shock wave lithotripsy in 10 patients, transurethral lithotripsy in 9 patients, and percutaneous nephrolithotomy in 2 patients. Stone-free status was achieved in 7 of 10 patients who were treated with shock wave lithotripsy (70%), 8 of 9 patients who were treated with transurethral lithotripsy (89%), and 2 of 2 patients who were treated with percutaneous nephrolithotomy (100%). All 4 patients who did not become stone-free after initial treatment (3 patients after shock wave lithotripsy and 1 patient after transurethral lithotripsy) became stone-free after secondary treatment with percutaneous nephrolithotomy (100%). No intraoperative complications occurred.

Conclusions: Minimally invasive procedures (mono-therapy or combination therapy) for urolithiasis in transplanted kidneys are safe and effective, and high overall stone-free results may be achieved.