Percutaneous nephrolithotomy in renal transplants: a safe approach with a high stone-free rate

The purpose of this report is to assess the safety and efficacy of percutaneous nephrolithotomies (PNL) in transplanted kidneys.

Patient characteristics, predisposing factors, clinical presentation, surgical details, complications and outcomes were analyzed.

Between April 2002 and August 2009, seven patients (average 44 years old, 4 women and 3 men) were treated. Predisposing factors included hyperuricemia, hyperparathyroidism, recurrent urinary tract infection (n = 2 each) and retained double-J ureteral stent (n = 1). Clinical presentation consisted of urinary tract infection alone (n = 3) or in association with impaired renal function (n = 2) but also hematuria (n = 1) or impaired renal function (n = 1). Patients were treated in supine position, and calyx puncture was guided by the combination of ultrasound and fluoroscopy. Combined ultrasound and pneumatic lithotripsy (n = 5) or extraction (n = 2) was performed. Overall average stone size was 32.8 mm (range 20-50). Mean operative time was 102 min (range 75-150). Stone-free status was achieved in 6 patients (85.7%). No intraoperative complications occurred, including major bleeding. Mean initial and postoperative serum creatinine levels were 2.04 and 1.59, respectively. Average admission time was 6.9 days (range 4-9).

PNL of transplanted kidneys is a safe and effective method associated with a high overall stone-free rate. This approach should be considered in centers where expertise is available.