A Case of Two Percutaneous Nephrolithotomies for Recurrent Transplant Kidney Stones Following Ureteral Stenosis Surgery Performed after Kidney Transplantation

Percutaneous Nephrolithotomy Success in the Transplant Kidney

Combined Liver-Kidney Transplantation for Primary Hyperoxaluria Type 2: A Case Report.

No. 572 Renal access for repeat percutaneous nephrolithotomy in patients with recurrent kidney stones: feasibility, safety and endourologic procedure outcomes

The intestinal microbiome of children with initial and recurrent nephrolithiasis: A pilot study and exploratory analysis

Background: nephrolithiasis is a common complex disease. It is the third most common disaster of the urinary tract, exceeded only by urinary tract infections and pathologic conditions of the prostate. About 50 % of recurrent stone formers have just one life time recurrence. At present, the great expansion in minimally invasive techniques has led to the decrease in open stone surgery (OSS). Extracorporeal shock wave lithotripsy (ESWL) has been introduced as an alternative approach which disintegrates stones in the kidney and upper urinary tract through the use of shock waves (SWs). Nevertheless, as there are limitations with the success rate in ESWL, other minimally invasive modalities for kidney stones such as percutaneous nephrolithotomy (PNL) are considered. Aim of the work: this study aimed to evaluate the effectiveness of ESWL VS PNL in management of non-lower polar medium sized stone (1-2 cm) as regards to stone size, location and number. Patients and Methods: this is a prospective randomized comparative clinical study that was conducted in Ain Shams Urology Department and Agouza Hospital Urology Department from December 2016 till September 2017.Sixty patients were enrolled; of which 30 patients underwent PNL and other 30 patients underwent Non-stented ESWL complaining of non-lower polar medium sized calyceal stones (1-2 cm). All patients were categorized into two subgroups; group A for ESWL and group B for PNL. Patients with lower calyceal stones, stone burden more than 2 cm, recurrent kidney stones, renal impairment, pregnant women and children were excluded from this study. Our study included 45 males (75%) and 15 females (25%) with a mean ± SD age 43.78±12.68 years (range 25 to 65). The patients’ criteria (age, sex, body mass index) and the stone characteristics (side, stone size, attenuation value and skin- to-stone distance) were compared between both groups. The SFR rate, the need for secondary procedures were calculated and compared. Results: 30 patients underwent PNL and the other 30 patients underwent Non-Stented ESWL. Twenty nine patients (96.6%) who underwent PNL rendered SFR detected by Non-enhanced Helical CT (Less than 4 mm) after one month; two cases 2 mm and 3 mm CIRF and only one case with 4 mm residual whereas only 5 patients (16.7%) in the ESWL group with high significance (P < 0.001) and all patients in PNL group were completed stone clearance without auxiliary procedure (p< 0.001). Conclusion: PNL is the modality of choice in medium sized (1-2cm) lower calyceal renal stone. PNL was more effective than ESWL for treating medium sized (1-2 cm) non lower polar renal stone, it has advantages of higher initial SFR with short time of treatment and lower auxiliary procedures (lower retreatment rate).However, ESWL was associated with fewer complications.

Objective: To report our experience in percutaneous nephrolithotomy and endoscopic urinary tract stone surgery in patients with urinary diversion and vesicostomy. Materials and Methods: Data of 21 patients with urinary diversion or vesicostomy who underwent surgery for urinary tract stones in our clinic between January 2008 and January 2020 were retrospectively analyzed. Eight patients (38%) underwent percutaneous nephrolithotomy, 2 patients (9.5%) underwent antegrade flexible ureteroscopy, 4 patients (19.0%) underwent retrograde semi-rigid or flexible ureteroscopy, 5 patients (23.8%) underwent retrograde pouch lithotripsy and 2 patients (9.5%) underwent percutaneous cystolithotripsy with vesicostomy tract entrance.Preoperative and postoperative data of the patients were evaluated. Results: The male to female ratio was 16/5. The mean age of the patients was 54.6 ± 10.1 years and mean preoperative stone diameter was 2.8 ± 4.5 cm. It was determined that 14 patients (66.6%) had ileal conduit (Bricker anastomosis), 5 patients (23.8%) had ureterocutaneostomy, and 2 patients (9.5%) had vesicostomy. Stone-free rate was 85.7% after single session of treatment. In the postoperative period, febrile urinary tract infection was observed in 4 (19.0%) patients, urinary system obstruction secondary to stone in 3 (14.2%) patients and anastomotic leakage in 1 (4.7%) patient. Conclusion: Percutaneous nephrolithotomy, antegrade ureterorenoscopy, retrograde ureterorenoscopy and vesicostomy entry cystolithotripsy are highly effective and safe methods in patients with urinary diversion and vesicostomy. The most important factors affecting the success are the experience of surgical team that can apply procedural options together with careful preoperative preparation and correct instrumentation.

Objective To analyze the technique and clinical effect of percutaneous nephrolithotomy combined with endoscopic balloon dilation in the treatment of upper ureterostenosis with recurrent renal calculi. Methods From June 2008 to June 2011,18 ureteral stenosis patients with the history of ureteral open surgery,postoperative residual or recurrent kidney stones were treated.There were 8 males and 10 females with the age of 27 -48 years.Fourteen cases were with hydronephrosis of 2 -4 cm,3 cases were with hydronephrosis of 5 -6 cm and 1 case was with hydronephrosis ＞6 cm.Subsequent stone size ＜ 1 cm was found in 15 cases,1 -3 cm in 3 cases,＞3 cm in 1 case.All patients were treated with percutaneous nephrolithotomy ultrasonic lithotripsy combined with balloon dilatation.The stone clearance rate,hydronephrosis changes,complications and IVP situation before and after surgery were analyzed. Results All the 18 cases were completed surgery successfully.There was 1 (6％) case with renal hemorrhage 3 days after the surgery and controlled with DSA hemostasis.There was 1 case accepted adjusting double-J tube by ureteroscopy.Sixteen (89％) patient's stones were completed removed.One case with residual calyceal stones size ＜5 mm was not further treated.There was 1 case treated with nephrectomy because of renal stone with infection.The patients were followed up for 6 to 36 months.Fourteen cases with hydmnephrosis improved significantly; 3 cases with no significant changes but improved following balloon dilation.All patients achieved significant improvement in imaging study comparing of preoperative and postoperative data. Conclusion The use of percutaneous nephrolithotomy combined with endoscopic balloon dilation is a safe and efffective treatment option in the treatment of kidney stones with ureteral stenosis. Key words: Nephrostomy,percutaneous; Percutaneous nephrolithotomy; Balloon dilation; Hydronephrosis; Ureteral stenosis

Observations on improving COVID-19 vaccination responses in kidney transplant recipients: heterologous vaccination and immunosuppression modulation

Effect of Urinary Intestinal Diversion on Urinary Risk Factors for Urolithiasis

IntroductionThe management of urinary tract stones, particularly de novo kidney allograft stones, presents unique challenges for kidney transplant recipients because of their prevalence and specific clinical considerations. Here, we describe a case in which percutaneous nephrolithotomy was successfully used to fragment a large kidney allograft stone ≥20 mm in size.Case presentationA 57‐year‐old woman who underwent ureteroureterostomy post simultaneous pancreas–kidney transplantation presented with gross hematuria after 15 years. Computed tomography revealed a 23‐mm stone in the transplanted kidney. Initial attempts at endoscopic combined intrarenal surgery were changed to percutaneous nephrolithotomy because of poor ureter mobility and tortuosity. Stone fragmentation was achieved using pneumatic and ultrasonic lithotripsy. A second procedure using Swiss LithoClast® Trilogy enabled complete stone clearance and ureteral stent placement.ConclusionBy understanding the peculiarities of the percutaneous approach, we demonstrated the safe and effective use of a pneumatic and ultrasonic lithotripter for kidney allograft stone fragmentation.

I have been invited to participate in this written debate, with Reem Al-Bareeq and John Denstedt, on the preferred treatment option for lower pole renal stones.

Background: Stones formation is a common complication after cystectomy including stones of the upper urinary tract and reservoir or conduit. Advances in instrumentation and techniques have expanded treatment options, while minimizing morbidity. Aims and Objectives: Feasibility of urolithiasis management after urinary diversion surgery. Materials and Methods: Eleven patients of diversion with stone were observed from January 01, 2015, to July 30, 2022. Operative procedures were decided on basis on stone locations and size. Perioperative parameters were observed and compared with similar studies. Percutaneous nephrolithotomy, percutaneous-based antegrade ureteroscopy with semi-rigid or flexible ureteroscope, transurethral reservoir lithotripsy, percutaneous pouch lithotripsy, and open operation were performed. The operative finding and complications were retrospectively collected and analyzed. Results: The mean age of the patients was 53.2±8.1 years and mean pre-operative stone diameter was 3.1±3.5 cm. Three patients suprapubic cystolithotomy, two patients percutaneous cystolithotripsy, two patients percutaneous nephrolithitomy, two patients extracorporeal shock wave lithotripsy, one patient per urethral cystolithotripsy/cystolitholapexy, and one patient ureteroscopy/flexible ureteroscopy were done. The male-to-female ratio was 9/2. Stone-free rate was 100% after single session of treatment. In the post-operative period, fever was observed in two patients, and urinary leakage through wound site in one patient. Conclusion: Stone surgery after urinary diversion is challenging, success of treatment depends on experience of surgical team, pre-operative preparation, and correct instrumentations.

Background: Stones formation is a common complication after cystectomy including stones of the upper urinary tract and reservoir or conduit. Advances in instrumentation and techniques have expanded treatment options, while minimizing morbidity. Aims and Objectives: Feasibility of urolithiasis management after urinary diversion surgery. Materials and Methods: Eleven patients of diversion with stone were observed from January 01, 2015, to July 30, 2022. Operative procedures were decided on basis on stone locations and size. Perioperative parameters were observed and compared with similar studies. Percutaneous nephrolithotomy, percutaneous-based antegrade ureteroscopy with semi-rigid or flexible ureteroscope, transurethral reservoir lithotripsy, percutaneous pouch lithotripsy, and open operation were performed. The operative finding and complications were retrospectively collected and analyzed. Results: The mean age of the patients was 53.2±8.1 years and mean pre-operative stone diameter was 3.1±3.5 cm. Three patients suprapubic cystolithotomy, two patients percutaneous cystolithotripsy, two patients percutaneous nephrolithitomy, two patients extracorporeal shock wave lithotripsy, one patient per urethral cystolithotripsy/cystolitholapexy, and one patient ureteroscopy/flexible ureteroscopy were done. The male-to-female ratio was 9/2. Stone-free rate was 100% after single session of treatment. In the post-operative period, fever was observed in two patients, and urinary leakage through wound site in one patient. Conclusion: Stone surgery after urinary diversion is challenging, success of treatment depends on experience of surgical team, pre-operative preparation, and correct instrumentations.

Percutaneous Nephrolithotomy in Children with Cystine Stone: Long-Term Outcomes from a Single Institution

Correction Regarding Kidney Stone Prevention