PMC8547566_01
CT reconstruction showing the patient's native kidneys (orange), the right flank transplanted kidney (blue) and the right iliac fossa transplanted kidney (violet)
12301_2021_249_Fig1_HTML.jpg
PMC8547566_01_12301_2021_249_Fig1_HTML.jpg
Fig1
One allograft was located in the right iliac fossa (upside-down implantation with ureteric anastomosis following Lich-Gregoir technique, violet in Fig. 1) and the other in the right flank (end-to-side uretero-ureteral anastomosis with native right kidney, blue and orange in Fig. 1).
Preoperative CT scan shows incomplete staghorn calculi in right iliac fossa transplanted kidney and right native and flank transplanted kidneys dilated by ureteral stone
12301_2021_249_Fig2_HTML.jpg
PMC8547566_01_12301_2021_249_Fig2_HTML.jpg
Fig2
Non-contrast computed tomography (NCCT) scan showed staghorn calculi in the kidney allograft implanted in the right iliac fossa composed of at least 3 stones of 12.5 mm, 13.7 mm and 10 mm located in superior, medium and inferior calyx, respectively (530 Hounsfield Units) (Fig. 2).
A Right native (upper kidney) and right flank transplanted kidneys dilated due to ureteral stones impacted in the uretero-ureteral end-to-side anastomosis. B Open-end ureteral catheter ascended after catheterization of the ureteroneocystostomy. Upper pole puncture of the right iliac fossa transplanted kidney under ultrasound guidance. C Antegrade flexible nephroscopy assessing residual fragments after finishing the percutaneous procedure
12301_2021_249_Fig3_HTML.jpg
PMC8547566_01_12301_2021_249_Fig3_HTML.jpg
Fig3
Endovision puncture was not attempted in order to protect the reusable flexible ureteroscope from an extreme proximal ureteral kinking loop (Fig. 3B). After most of the stone fragments had been removed, antegrade flexible nephroscopy (Flexible Fiber-Cystoscope 15Fr, Richard Wolf, Germany ) was conducted to search for residual stones in locations that were inaccessible with the rigid nephroscope (Fig. 3C).
Postoperative CT scan without neither residual fragments nor subcapsular hematoma
12301_2021_249_Fig4_HTML.jpg
PMC8547566_01_12301_2021_249_Fig4_HTML.jpg
Fig4
Postoperative NCCT scan, performed 12 h postoperatively, showed neither residual fragments nor suggestive signs of immediate postoperative complications (Fig. 4).