Management of urolithiasis in renal transplantation

Objective: To report our experience with extracorporeal shock wave treatment for upper urinary tract stones in transplanted kidneys. Patients and Methods: A total of eight patients underwent extracorporeal shock wave lithotripsy (SWL) in prone position under analgosedation with the Dornier MPL 9000 lithotripter or the Storz Modulith SLX lithotripter employing ultrasound targeting. The stones had overall diameter ranging 7-12 mm and were located in the renal calices in 5 cases and in the ureter in 3 cases. Five stones were radiopaque and 3 radiolucent. Results: Stone fragmentation was obtained in 87% of the patients and 75% became stone free within 90 days. Serum creatinine values and creatinine clearances remained stable within 30 days post-operatively in all the treated patients. Conclusions: SWL in transplanted kidney is feasible and simple to perform when the patient is treated in prone position with ultrasound targeting and without any complication or deterioration of renal function. Results similar to those achievable in native kidneys can be obtained also in graft kidneys with limited endourological antero-retrograde ancillary manouvres.