Ileal conduit staple reflux: a nidus for renal calculi

Abstract

A man with an ileal conduit urinary diversion presented with microscopic hematuria. His ileal conduit was formed at another institution more than 10 years earlier. As part of his workup, a retrograde contrast study of his ileal conduit was performed. The preliminary KUB revealed two calcifications, one in the right lower quadrant and the other in the left upper quadrant (Fig. 1). Further inspection demonstrated that both stones were superimposed on fine intestinal staples (Fig. 2A, B). The operative report confirmed usage of an intestinal stapling device to close the proximal end of the ileal conduit. Retrograde contrast into the ileal conduit illustrates the presence of both stones within the urinary tract and encasing intestinal staples. The left renal stone demonstrates staple reflux into a lower pole renal calyx (Fig. 3A, B). An exhaustive MEDLINE search revealed 1 prior reported case of staple reflux from urinary diversions.1 Patients with urinary diversions are at increased risk for urinary tract calculi.2 This case illustrates a theoretical concern with the use of permanent stapling material in urinary diversions. With time, the staples can migrate into the lumen of the urinary diversion and act as a nidus for calculi.