Abstract
ABSTRACTObjectiveTo present our experience in minimally invasive management of urinary tract stones in patients with urinary diversion.Materials and MethodsWe retrospectively reviewed 26 patients with urinary tract stones after cystectomy and urinary diversion. The types of urinary diversion were ileal conduit, colon conduit, ileal orthotopic neobladder in 19, 4, and 3 patients, respectively. At postoperative days 2, a plain KUB and urinary ultrasonography were performed in order to assess stone fragmentation or hydronephrosis. According to postoperative imaging, stone free rate (SFR) was defined as complete absence of fragments or residual stones less than 4mm.Results19 patients were treated with minimally invasive percutaneous lithotripsy (MPCNL) and 2 patients required second-look MPCNL. Anterograde flexible ureteroscopy was performed in 2 patients, while in 2 patients a combined anterograde and retrograde approach was required. Three reservoir stones were treated by transurethral neo-bladder lithotripsy. Postoperative significant complications occurred in 2 patients (7.7%). The highest percentage of stone composition was struvite, as a result of chronic urinary tract infection (UTI). SFR was 88.5% (23 of 26).ConclusionsOur experience showed that MPCNL is a safe and effective treatment modality with little morbidity for renal and upper ureteral stones in patients with urinary diversion. For middle and lower ureteral stones, an anterograde approach could be also considered as a first line treatment, but a combined anterograde and retrograde approach was required when the anterograde access alone cannot provide acceptable results.
Highlights
Radical cystectomy followed by urinary diversion is the treatment of choice for muscle invasive bladder cancer [1, 2]
Patients with urinary diversion are highly predisposed to uretero-intestinal anastomotic strictures and urolithiasis as refluxing urine and pouch stasis may contribute to an increased risk for stone formation
The objective of the present study is to review our experience, and assess the safety and efficacy of minimally invasive management of urinary tract stones in 26 patients with urinary diversion after cystectomy
Summary
Radical cystectomy followed by urinary diversion is the treatment of choice for muscle invasive bladder cancer [1, 2]. Patients with urinary diversion are highly predisposed to uretero-intestinal anastomotic strictures and urolithiasis as refluxing urine and pouch stasis may contribute to an increased risk for stone formation. Stone formation rate ranges from 9.0% to 26.5%, in this category of patients [3-5]. Urologists can be technically challenging for tissue adhesion after intestinal bladder reconstruction, ureteral anastomotic stricture and changes in patient health status. The management of urinary tract stones in patients with urinary diibju | Endourologic strategies in patients with urinary diversion version are varied, including PCNL, SWL, percutaneous based anterograde ureteroscopy, anterograde-retrograde combined ureteroscopy and even open approach [6, 7]. Many factors must be considered in the treatment modality selection, such as stone size, stone location, diversion type, patient fitness and surgeon experience [8]
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Schedule a callMore From: International braz j urol : official journal of the Brazilian Society of Urology
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