OBJECTIVE To report our experience with minimally invasive percutaneous nephrolithotomy (mPCNL) for upper urinary tract (UUT) calculi in transplanted kidneys. PATIENTS AND METHODS Between August 2002 and June 2006, seven patients (mean age 40.7 years) with UUT stones in transplanted kidneys (including one staghorn, two pelvic and four ureteric stones) were treated by mPCNL. A 16 F peel-away sheath was placed as the percutaneous access port and a 8.5/11.5 F nephroscope or a 8/9.8 F ureteroscope was used for manipulation. Every 2-3 months during the follow-up, patients had their serum urea, creatinine and uric acid measured, with urine culture and ultrasonography. RESULTS All patients were rendered stone-free at one mPCNL procedure, with no complications during or after surgery. The mean (range) operative duration was 53 (20-100) min and the mean haemoglobin decrease was 0.55 (0.2-1.2) g/dL. At a mean (range) follow-up of 23 (3-48) months renal allograft function was stable in all patients and no recurrence of stone was detected. CONCLUSIONS mPCNL is safe and effective for managing calculi in transplanted kidneys, and it can be the initial therapy for most cases of UUT stones in transplanted kidneys, except for simple and small stones in the middle or lower calyx.

Minimally invasive percutaneous nephrolithotomy for upper urinary tract calculi in transplanted kidneys.

Standard percutaneous nephrolithotomy (PCNL) with a 28–30Fr tract size is an established method for renal stone removal. PCNL using a small tract (12–20Fr) has been reported but was considered applicable in specific conditions only.We review the experience of small-tract PCNL in the literature with particular reference to the experience in China by the Guangzhou group. The technique according to the Chinese method is described. We then report our initial experience of minimally invasive PCNL (MPCNL) using the same technique and discuss how MPCNL should have a greater role in upper tract stone management.

Minimally Invasive Percutaneous Nephrolithotomy (MNPCNL) According to the Chinese Method

The purpose of this chapter is to outline the history of the development of shock wave lithotripsy (SWL) of renal and ureteral stones in China and to present our experiences. The technological aspects and clinical use of Chinese lithotripters are further described. Most lithotripters used for SWL in China are indigenously produced. Lithotripter fabrication began relatively early in China; consequently, our lithotripters have developed distinctive technical characteristics that result in an advantageous cost-benefit ratio, shock waves of lower peak pressure and broader focal zone, and a greater opportunity for anesthesia-/analgesia-free and sedation-free SWL. A single ultrasound is the predominant mode for imaging. Today, SWL has become the first-line modality for renal and ureteral stones across China. Our recommended indications for SWL are similar to the European Association of Urology (EAU) and American Urological Association (AUA) guidelines on urolithiasis. In practice, patients often prefer and select SWL in preference to other modes of treatment due to the aforementioned characteristics. The reported results of SWL in China show comparable or even higher stone-free rates at 3 months; however, there is a higher re-treatment rate compared to Western countries’ reported literature. Auxiliary procedures are less used in SWL in China. In our experiences, the most frequent and commonly seen complication post-SWL was temporary hematuria. Other complications were infrequent, and serious complications were rarely reported. In recent years in China, SWL has also been widely used to treat children with renal and ureteral stones. For such cases, serious complications rarely occurred, and the few long-term studies have yet to show any evidence of negative effects of SWL on children’s renal morphology and function.

SWL of Renal and Ureteral Stones: The Chinese Experience

目的 探讨腔内治疗移植肾尿路结石的效果和策略.方法采用腔内技术治疗13例移植肾尿路结石,其中肾结石3例,金属支架结石1例,输尿管结石9例,合并输尿管口狭窄2例.结石最大直径8～48 mm,接受肾移植的时间1个月～8年.结果3例肾结石和1例金属支架结石行经皮微造瘘输尿管镜取石术成功取石.4例输尿管结石行逆行输尿管镜取石治疗;3例行经皮顺行输尿管镜取石成功,其中1例合并移植输尿管口狭窄者同时行内切开取石;1例移植输尿管口狭窄合并下端结石者,改行开放手术;1例输尿管结石直接行体外冲击波碎石术2次后排净结石.术后随访l～8年,人肾存活均良好,12例患者肾功能恢复正常,无结石复发.结论移植肾尿路结石处理应选择创伤小、效果好的腔内微创治疗,尽可能保护肾功能。

Endoscopic treatment of urinary calculi in allograft kidneys

目的 探讨复式脉冲HB-V型低能量体外冲击碎石术(ESWL)治疗各种上尿路结石的效果.方法采用复式脉冲HB-ESWL-VG型低能量碎石机治疗符合ESWL适应证的上尿路结石717例,工作电压3～9 kV.其中直径≤2.0 cm肾结石467例,平均冲击次数2300次;直径≤1.0 cm输尿管结石250例,平均冲击次数2800次.结果上中盏结石排净率89.5%(170/190),复打率13.2%(25/190);下盏结石排净率81.6%(169/207),复打率17.4%(36/207);肾盂结石排净率92.9%(65/70),复打率5.7%(4/70);输尿管结石总排净率95.2%(238/250),总复打率6.4%(16/250).碎石过程中出现轻度疼痛者107例(14.9%),治疗后出现肉眼血尿者687例(95.8%),1～3 d后血尿消失.无肾周血肿等严重并发症.结论复式脉冲低能量ESWL治疗上尿路结石成功率高,复打率低,副作用少,无严重并发症。

Treatment of renal and ureteral calculi with duplex pulse low-energy ESWL (report of 717 cases)

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Endoscopic treatment of urinary calculi in allograft kidneys

Treatment of renal and ureteral calculi with duplex pulse low-energy ESWL (report of 717 cases)