Emerging Perspectives in TransplantationRenal transplantationFlexible Ureterorenoscopy and Laser Lithotripsy for the Treatment of Allograft Kidney Lithiasis

- Flexible ureterorenoscopy is feasible in the allograft kidney.
- Flexible ureteroscopy is an effective treatment modality in allograft kidney lithiasis.
- Flexible ureteroscopy is safe in allograft kidney lithiasis.

ObjectiveTo evaluate the safety and effectiveness of flexible ureterorenoscopy (F-URS) and laser lithotripsy for the treatment of allograft kidney lithiasis.Patients and MethodsIn a retrospective analysis of 897 consecutive renal transplantations that were performed at our center between February 2008 and December 2014, 6 patients were found to have allograft lithiasis. F-URS and laser lithotripsy were performed 6 times on 5 patients (twice for 1 patient who had stone recurrence after 6 months). Percutaneous nephrolithotomy was used for the remaining patient. Patient demographics and stone characteristics (age, sex, stone size, stone analysis, location, history of shockwave lithotripsy) and perioperative measures (duration of operation, fluoroscopic imaging, success and complication rates) were reviewed. In addition, the technical difficulties of standard F-URS procedures in transplanted kidneys were reviewed and some facilitative techniques were defined to increase the success rate.ResultsA total of 5 patients underwent 6 F-URS procedures and laser lithotripsy operations for renal graft lithiasis. The mean stone size was 9.2 mm (7.5-11 mm). The mean operation and fluoroscopy times were calculated as 55 minutes (40-70 minutes) and 57.5 seconds (40-80 seconds), respectively. Treatment was successful in all patients and no severe complications or mortality occurred. One patient experienced transient hematuria and recovered within 36 hours.ConclusionF-URS is a safe, effective, and minimally invasive treatment modality for small- and medium-sized stones in allograft kidney lithiasis.