Renal autotransplantation and modified pyelovesicostomy for intractable metabolic stone disease.

Abstract

PURPOSE:

Some patients with intractable metabolic stone disease experience narcotic dependence, which cannot be managed with standard treatments. We offered these patients renal autotransplantation with a modified pyelovesicostomy as an alternative solution.

MATERIALS AND METHODS:

Renal autotransplantation with pyelovesicostomy was performed for 15 kidneys in 12 patients (3 bilateral, 2 solitary), 9 female and 3 male, with a mean age of 33.8 years (range 16 to 55). The etiology of metabolic stone disease was calcium oxalate (40%), cystinuria (33%), type 1 renal tubular acidosis (14%), calcium oxalate/urate (7%) and medullary sponge kidney (7%). Patients reported that lifetime stone events ranged from 10 to more than 70, that underwent an average of 3 to 4 surgical interventions per year in the previous 2 years and that they were dependent on daily oral narcotics for stone related pain.

RESULTS:

All 15 kidneys were successfully autotransplanted with a mean followup of 41.8 months (range 3 to 74). We used a modified pyelovesicostomy with ureteral strip in 13 and standard Boari tube in 2 cases. All patients continued to pass small stone debris per urethra with minimal symptoms. Of 12 patients 11 (92%) were weaned off daily narcotics. There have been 17 stone episodes in 4 patients (3 cystinuria) for which medical intervention and pain medication was required. The number of urological procedures/patients before (155/12 [12.9]) and after (8/12 [0.66]) autotransplantation was dramatically reduced (paired t test p = 0.0001). The preoperative mean estimated glomerular filtration rate was 77.2 cc/minute, and 73.5, 71.9, 79.2 cc/minute at 12, 36 and 60 months, respectively.

CONCLUSIONS:

Renal autotransplantation and pyelovesicostomy offer patients with intractable metabolic stone disease the opportunity to improve quality of life and to decrease daily narcotic use.

• Authors: Stuart M Flechner, Mark Noble, Ho Yee Tiong, Kathy L Coffman, Alvin Wee
• Journal: The Journal of urology (J Urol) Vol. 186 Issue 5 Pg. 1910-5 (Nov 2011) ISSN: 1527-3792 [Electronic] United States
• PMID: 21944098 (Publication Type: Journal Article)
• Copyright: Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Chemical References

• Creatinine

Topics

• Adolescent
• Adult
• Anastomosis, Surgical
• Creatinine (blood)
• Female
• Glomerular Filtration Rate
• Humans
• Kidney Calculi (chemistry, surgery)
• Kidney Transplantation (methods)
• Male
• Middle Aged
• Plastic Surgery Procedures (methods)
• Transplantation, Autologous
• Ureter (surgery)
• Young Adult