OBJECTIVE: To present our experience in surgical management of urolithiasis in patients after urinary diversion.
PATIENTS AND METHODS: Twenty patients with urolithiasis after urinary diversion received intervention. Percutaneous nephrolithotomy, percutaneous based antegrade ureteroscopy with semi-rigid or flexible ureteroscope, transurethral reservoir lithotripsy, percutaneous pouch lithotripsy and open operation were performed in 8, 3, 2, 6, and 1 patients, respectively. The operative finding and complications were retrospectively collected and analyzed.
RESULTS: The mean stone size was 4.5±3.1 (range 1.5-11.2) cm. The mean operation time was 82.0±11.5 (range 55-120) min. Eighteen patients were rendered stone free with a clearance of 90%. Complications occurred in 3 patients (15%). Two patients (10%) had postoperative fever greater than 38.5°C, and one patient (5%) suffered urine extravasations from percutaneous tract.
CONCLUSIONS: The percutaneous based procedures, including percutaneous nephrolithotomy, antegrade ureteroscopy with semi-rigid ureteroscope or flexible ureteroscope from percutaneous tract, and percutaneous pouch lithotripsy, provides a direct and safe access to the target stones in patients after urinary diversion, and with high stone free rate and minor complications. The surgical management of urolithiasis in patients after urinary diversion requires comprehensive evaluation and individualized consideration depending upon the urinary diversion type, stone location, stone burden, available resource and surgeon experience.
Written by:
Zhong W, Yang B, He F, Wang L, Swami S, Zeng G. Are you the author?
Department of Urology, the First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, China; Department of Gynecology and Obstetrics, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson, Tennessee, United States of America; Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States of America.
Reference: PLoS One. 2014 Oct 31;9(10):e111371.
doi: 10.1371/journal.pone.0111371
PubMed Abstract
PMID: 25360621