MP37-08 RENAL TRANSPLANT UROLITHIASIS MANAGEMENT: A SYSTEMATIC REVIEW

Abstract

You have accessJournal of UrologyRenal Transplantation & Vascular Surgery I (MP37)1 Sep 2021MP37-08 RENAL TRANSPLANT UROLITHIASIS MANAGEMENT: A SYSTEMATIC REVIEW Krishna Ravivarapu, Alexander Small, Nir Tomer, Evan Garden, and Michael Palese Krishna RavivarapuKrishna Ravivarapu More articles by this author , Alexander SmallAlexander Small More articles by this author , Nir TomerNir Tomer More articles by this author , Evan GardenEvan Garden More articles by this author , and Michael PaleseMichael Palese More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002046.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Renal transplant urolithiasis is an uncommon but serious issue. Management of these stones is challenging due to the urgency of an obstructed solitary kidney plus technical issues accessing a transplant. Treatments include observation, extracorporeal lithotripsy (ESWL), ureteroscopy (URS), percutaneous nephrolithotomy (PNL), and open surgical pyelotomy. There are currently no established guidelines for the management of transplant stones and comparative effectiveness research is lacking. We performed a critical systematic review of contemporary research to evaluate practice patterns and stone-free rates (SFR) among the interventions. METHODS: A systematic review was conducted for all English-language abstracts and peer-reviewed articles using the Pubmed, MEDLINE, Scopus, and Google Scholar databases from January 2010 to January 2020. Case-reports were excluded from analysis. Two authors independently extracted data on stone location, size, treatment approach, and SFR. RESULTS: 835 publications were screened and 11 were included in this analysis, with a total of 268 renal transplant urolithiasis patients. In 15,624 total transplants, overall urolithiasis incidence was 1.1% (0.4-2.4%). Average stone size was reported in 6 studies and was 12.2 mm (7.4-19.9 mm). Stones were identified in the kidney (51.7%) and ureter (48.3%). Primary treatments included ESWL 27.2%, URS 25.0%, PNL 13.4%, and open pyelotomy 4.5% with SFR 64.1% (0-100%), 87.1% (60-100%), 91.9% (75-100%), and 90.9% (50-100%) respectively. The overall stone-free rate across all first line treatments was 79.1%. Secondary treatments were reported in 41 patients - the approaches were observation (53.7%), PNL (19.5%), URS (14.6%), open pyelotomy (9.8%), and ESWL (2.4%). CONCLUSIONS: Renal transplant urolithiasis poses unique challenges to both patients and providers. This review represents a contemporary snapshot of global treatment strategies and comparative effectiveness. The most common approaches are observation, ESWL and URS, however the most definitive strategies are PNL and open pyelotomy. Ultimately, the approach should be tailored to the individual patient depending on stone size, location, patient anatomy, and surgeon experience. Future prospective studies of renal transplant urolithiasis can shed light on specific risk factors for stone formation as well as optimal treatment protocols. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e648-e648 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Krishna Ravivarapu More articles by this author Alexander Small More articles by this author Nir Tomer More articles by this author Evan Garden More articles by this author Michael Palese More articles by this author Expand All Advertisement Loading ...