Exvivo stone surgery in donor kidneys at renal transplantation.

Abstract

To report our experience on the outcomes of exvivo ureteroscopy and exvivo pyelolithotomy carried out on the donor kidney before living donor renal transplantation. Between 2009 and 2016, 13 stone-bearing donor kidneys underwent exvivo bench surgery after donor nephrectomy. Of these, six patients underwent exvivo ureteroscopy and seven patients underwent exvivo pyelolithotomy. Data were analyzed for technical feasibility, intraoperative and postoperative complications, stone clearance, and stone recurrence. The mean stone burden was 9.1mm (range 5-15mm). Renal collecting system access and stone extraction were successfully achieved, and a stone-free status was accomplished with both techniques. The mean duration of exvivo ureteroscopy was 12.5min (range 9-20min), and the mean duration of exvivo pyelolithotomy was 3.1min (range 1-8min). One patient in the pyelolithotomy group developed urinary leakage and underwent surgical repair on the third postoperative day. The mean long-term follow-up duration was 49.6months (range 14-101months). None of the 13 patients included in the study suffered from stone recurrence. Our experience suggests that both exvivo ureteroscopy and exvivo pyelolithotomy procedures can safely and effectively be carried out in stone-bearing living donor kidneys, without compromising renal allograft function.