Current trends in the treatment of urological patients with transplanted kidney

The examination and surgical treatment were performed in 34 kidney recipients (22 males and 12 females aged 16-65 years) with different urological diseases admitted to the urological clinic of M.F. Vladimirsky Moscow Region Research Clinical Institute in 1992-2007 3 weeks to 15 years after kidney transplantation. Most of the patients had urolithiasis, prostatic adenoma, some patients had renal cyst, implanted kidney tumor, tumor of the arteriosclerotic kidneys, posterior urethra stricture, posterior urethra valve. The recipients with such urological diseases as chronic pyelonephritis, vesicoureteral reflux, chronic prostatitis, chronic cystitis received conservative treatment outpatiently. Extracorporeal lithotripsy (ELT) was made in 12 patients (each patient, except one, was exposed to 2 sessions, one patient - 3) - a total of 27 sessions. After the first ELT session fragments of the concrements (mean size 2-5 mm in diameter) evacuated spontaneously. Transurethral (retrograde) x-ray-endoscopic operations for removal of the transplanted kidney uroliths were not conducted as the newly created ostium in the upper part of the urinary bladder made it impossible to use a retrograde approach for elimination of the concrements. Kidney recipients with prostatic adenoma (2 and 5 years after transplantation) in 3 cases were subjected to scheduled TUR because of manifest obstructive symptoms. Four patients with AUR undergoing TUR showed intraoperative tissue hemorrhage as the operation was conducted during anticoagulant and anti-platelet therapy used early (3 months to 2 months after the transplantation. In view of this, TUR lasted longer as adequate hemostasis was needed. Urethral nitinol stenting was made in one patient with AUR and prostatic size over 60 cm3, TUR was made 4 months later. Thus, low invasive surgical interventions in kidney recipients with urological diseases have changed routive approaches to treatment of such patients consisting in open surgery which was often cancelled because of contraindications. ELT is a basic method of treatment of the transplants uroliths, in other cases different endourologic interventions are used. Prostatic adenoma is treated, as a rule, surgically (TUR of the prostate).