Percutaneous management of stones in transplanted kidneys

Stone disease is a rare complication after renal transplantation, and the management of these stones can be difficult. In many cases, the best modality to treat stones in transplanted kidneys/ureters is with a percutaneous approach. The goal of this study was to review our series of percutaneous nephrolithotomy (PNL) to evaluate the success rates and present the key technical points to achieve a successful outcome.

We retrospectively reviewed our series of PNL from January 1997 to December 2007 and identified 15 patients who had had PNL performed in a transplanted kidney. We evaluated multiple perioperative variables and how the patients' urolithiasis presented. We also collected intraoperative data.

A total of 15 patients underwent successful PNL in a transplanted kidney. In all patients, but 3, access into an anterior, upper pole calix was achieved, and access was obtained with ultrasound guidance alone or a combination of ultrasound guidance and fluoroscopy. Ten patients had a pre-existing nephrostomy tube, and this was used in all but 1 patient. Of the 15 patients, 8 (53%) were treated with percutaneous flexible nephroscopy/ureteroscopy, and 7 had tracts dilated to 30F to perform rigid PNL. All patients were rendered stone free at the end of the procedure, no complications developed, and no patient required a blood transfusion.

Nephrolithiasis in a transplanted kidney can be challenging to diagnose and to treat. PNL is most often the best modality to render patients stone free.