Videos | Transplant ureteric stone removal | Which Medical Device

This patient was admitted with acute deterioration in renal function of a transplant kidney associated with sepsis. Ultrasound demonstrated a hydronephrosis and plain films showed a probable stone in the distal transplant ureter. A nephrostomy and stent were requested with a view to ureteroscopy and stone extraction once the acute episode had passed.

Ureteroscopy of transplant ureters is very difficult due to the variable position of the ureteric anastamosis to the bladder.

A nephrostomy was performed. There were two ureteric stones, a smaller proximal stone and a large distal obstructing stone. A 6mmx2cm angioplasty balloon (Biotronik Paseo) was used to push the stone into the bladder relieving the obstruction and avoiding the need for stent. The balloon was then pushed back down the ueter to remove any smaller fragments and ensure the anastamosis was not stenotic. A 7F nephrostomy was left in situ to perform a check nephrostogram afer 48hrs.

I have previously used this technique in CBD stones but never in a transplant ureter. I suspect this would be quite painful in the non transplant ureter.

Dr Phil Haslam

Consultant Interventional Radiologist, Freeman Hospital, Newcastle upon Tyne.