Management of coralliform lithiasis on renal allograft with bricker-type ureterointestinal anastomosis

The authors report the management of a coralliform lithiasis that occurred in a renal allograft in association with a Bricker ureterointestinal anastomosis for urinary diversion.

A 58-year-old patient with a significant previous urological history, ie, surgery for childhood incomplete bladder extrophy, trans-ileal Bricker type ureterostomy, and in the end a renal allograft, presented with hematuria and septicemia. Complete radiological examination revealed an obstructive upper tract coralliform lithiasis in the transplanted kidney. A percutaneous nephrolithotomy also was performed for surgical treatment.

On postoperative day 2, a urinary fistula was observed at the nephrostomy orifice. The Bricker ureterointestinal anastomosis was located at the same level as the nephrostomy orifice, which maintained upper urinary high pressures as well as the fistula.

Possible preexistent lithiasis in a donor kidney should not be overlooked. In the management of kidney stones larger than 3 cm, percutaneous nephrolithotomy remains the "gold standard" procedure even in cases of external urinary diversion. We proposed an original management of the previously described postoperative complication using a hyperpression drainage tube device in association with a JJ stent.