病例報告及文獻回顧: 使用軟式輸尿管鏡於體外移除移植腎內結石

李亞哲、周詠欽、洪啟峰

嘉義基督教醫院 外科部 泌尿科

 Ex Vivo treatment of stones in donor kidney by retrograde intrarenal surgery: A case report and review of the literature

Ya-Che Lee, Yeong-Chin Jou, Chi-Feng Hung

Divisions of Urology, Department of Surgery, Chiayi Christian Hospital

Introduction:

Lithiasis in the donor kidney has been considered a relative contraindication. However, deceased donor kidney transplantation programs in developing countries are still in the evolving phase. Stones should, if possible, be removed before transplantation (ex vivo). At our knowledge, this case report is the first to present removal of stones through ex vivo retrograde intrarenal surgery in the donor kidney.

Case presentation:

A 59-year-old Asian female with history of fall down accident and dilated pupils without light reflex and loss consciousness when brought to emergency department. Intracerebral and subdural hemorrhage, skull fracture and brainstem dysfunction were diagnosed. She registered the consent to become an organ and tissue donor before. Computed tomography showed two stones, one located in middle and the other in the lower calyx. After the harvest of the graft kidney, a 9.5 Fr retrograde intrarenal surgery was performed through the ureter stump. Under direct vision, two stones were removed by nitinol stone retrieval baskets in an iced preservation solution bath in 5 minutes. After these procedures, the kidney was implant to the recipient uneventfully with immediately postoperative urine output.

Discussion:

Stones in the renal collecting system of kidney donor are a rare clinical problem and present a relative contraindication to kidney transplantation. Because of the grafts shortage and the development of contemporary endourological techniques, successful management has been achieved. There are no diagnostic and therapeutic standards with respect to detection and treatment of nephrolithiasis in donor kidneys. The recommended method of stone removal is endoscopic treatment, which may be conducted ex vivo before the organ transplantation, including ureteroscopy and pyelolithotomy. The method of treating renal calculi depends on the size and location of calculi. In kidney donors stones smaller than 10mm can be treated by extracorporeal shock wave lithotripsy(ESWL) or retrograde intrarenal surgery(RIRS), these are the recommendations of the European urology association. There are no cases in literature of donor kidneys underwent ex vivo bench retrograde intrarenal surgery after donor nephrectomy.

Conclusions:

Our experience suggests that ex vivo retrograde intrarenal surgery procedures can safely and effectively be carried out in stone‐bearing donor kidneys, without compromising renal allograft function.