Surgical and Metabolic Management of Urolithiasis Following Bladder Reconstruction

Abstract

Urolithiasis occurs in up to 52 % of patients who undergo urinary diversion for any cause. The anatomic and metabolic alterations that occur at the time of bladder reconstruction with intestinal segments results in significant risk factors for stone formation unique to this patient population. Furthermore, the risk of urinary tract colonization with urease-producing bacteria further enhances their risk of urolithiasis. While primary prevention is paramount, surgical management is often necessary to remove stones that develop in patients with urinary diversion. In this review, we discuss the particular risk factors associated with urolithiasis in patients with urinary diversion, as well as medical and behavioral interventions to minimize risk of stones and to prevent recurrent stone formation. We also discuss the particular intricacies of surgical management of stones in both the upper and lower urinary tracts in patients with all types of diversions and provide an evidence-based approach to treatment of urolithiasis in this complex patient population.