V02-04 MINI-PCNL FOR TRANSPLANT NEPHROLITHIASIS

Abstract

You have accessJournal of UrologyCME1 Apr 2023V02-04 MINI-PCNL FOR TRANSPLANT NEPHROLITHIASIS Kavita Gupta, Kevin Liu Kot, Dima Raskolnikov, Charbel Chalouhy, and Alexander Small Kavita GuptaKavita Gupta More articles by this author , Kevin Liu KotKevin Liu Kot More articles by this author , Dima RaskolnikovDima Raskolnikov More articles by this author , Charbel ChalouhyCharbel Chalouhy More articles by this author , and Alexander SmallAlexander Small More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003232.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical management of transplant nephrolithiasis has many challenges. Technically, access to the kidney is limited by the neoureteral orifice, tortuous ureteral path and variable orientation of the kidney. We present a case of a 72-year old man with history of liver and kidney transplant 6 years prior who was found to have 1.9 cm and 0.9 cm stones in the transplant kidney. We demonstrate how endoscopic combined intrarenal surgery (ECIRS) and mini-percutaneous nephrolithotomy (mPCNL) can help improve stone clearance in transplant kidneys. METHODS: Percutaneous access to the kidney was previously obtained and a nephrostomy tube had been placed. In the operating room, the patient was positioned into lithotomy position. During cystoscopy, the transplant ureteral orifice in the right dome was accessed with an angled 0.038" hybrid wire. Retrograde pyelogram and nephrostogram showed an upside down lie of the kidney and a sharp angle at the ureteropelvic junction (UPJ). A 22 cm 12/14 Fr ureteral access sheath was placed up to the mid ureter and a flexible ureteroscope was passed into the kidney. There was sharp angulation at the UPJ which limited mobility of the scope. An impacted stone was visualized within the renal pelvis. Percutaneous access to the lower pole was established using the nephrostomy tube. Dilation was performed with an 18 Fr balloon and a sheath was placed. The Storz MIPS 12 Fr rigid nephroscope was placed into the field and the stones were visualized. Using the 200 um Holmium laser fiber, we fragmented the stones at a setting 1 J×20 Hz. The fragments were vortexed out and extracted with the nitinol basket. Simultaneously, retrograde ureteroscopy was used to ensure complete clearance of the stones. Additional stone fragments were encountered in the extreme lower pole below the sheath and further fragmented and extracted until stone-free. The scope was removed and a nephrostomy tube was placed. A 6 Fr×22 cm ureteral stent was advanced retrograde. A foley catheter was placed. RESULTS: Estimated blood loss was minimal. A CT abdomen and pelvis without contrast on post-operative day 1 showed no residual stone burden. The nephrostomy tube and foley catheter were removed, and the patient was discharged home. His ureteral stent was removed in the office one month later. The patient remained symptom free. CONCLUSIONS: Our video demonstrates the utility of ECIRS and mPCNL during transplant PCNL due to the complexity of the anatomy. In addition, ECIRS can improve stone clearance and overcome some of the challenges of transplant endoscopic surgery. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e169 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kavita Gupta More articles by this author Kevin Liu Kot More articles by this author Dima Raskolnikov More articles by this author Charbel Chalouhy More articles by this author Alexander Small More articles by this author Expand All Advertisement PDF downloadLoading ...