O'Brien peel-away sheath: an alternative for allograft percutaneous nephroscopy

Percutaneous access and antegrade intervention remains the gold standard in the management of renal and ureteral complications in the renal transplant recipient. Current techniques with large nephrostomy sheaths and instrumentation carry significant morbidity in this patient population. We present our experience with a modification of the standard nephroscopic approach using a smaller (16F) O'Brien suprapubic peel-away introducer and sheath to access the allograft renal pelvis and allow manipulation with a smaller-caliber endoscope, with the purpose of attaining similar treatment outcomes with less morbidity in this subset of patients. Fourteen renal transplant patients with indications for antegrade management of renal or proximal ureteral complications had successful endoscopic intervention through the smaller sheaths without suffering any intraoperative or postoperative complications at a mean follow-up of 22 months (range 8-37 months). The mean operative time was 140 minutes (33-190 minutes), which is not significantly different from our operative time using standard instrumentation.