PURPOSE: We report our experience with ureteroscopy, percutaneous nephrolithotomy (PCNL), and shock wave lithotripsy (SWL) for the treatment of symptomatic stone disease in patients with ileal conduit urinary diversions.
MATERIALS AND METHODS: Retrospective chart review of all patients treated with cystectomy and ileal conduit urinary diversion from 1982 to June of 2010 who subsequently developed urolithiasis was performed.
RESULTS: We identified 77 patients who developed urolithiasis requiring surgical intervention after ileal conduit urinary diversion. Average treatment age was 62.5 years (30-82). Mean follow-up was 7.1 years (0.1-24.3). Primary mode of therapy was percutaneous nephrolithotomy (PCNL) in 48 (62.3%), extracorporeal shock wave lithotripsy (SWL) in 20 (26.0%) and ureteroscopy in 9 (11.6%), patients. Average stone size was larger for PCNL (2.1 cm) compared to ureteroscopy (0.9 cm) or SWL (1.0 cm), (p< 0.0001). Total complication rates were similar between groups: 29% PCNL, 30% SWL, and 33% ureteroscopy, (p=0.9). Stone-free status was higher in the PCNL (83.3%) cohort compared to the ureteroscopy (33.3%) or SWL (30%), (p< 0.0001). The retreatment rate was not significantly different between groups with 66.7% of the ureteroscopy group requiring subsequent procedures compared to 29.2% of PCNL and 45% of SWL (p=0.08). Change in mean preoperative and current calculated glomerular filtration rate was not significantly different amongst the three treatment groups.
CONCLUSIONS: Treatment of urolithiasis in patients with urinary diversion is associated with high retreatment and complication rates. PCNL achieves better stone-free outcomes than ureteroscopy or SWL; however, there was no difference in ancillary procedures or complication rates between the three treatment modalities.
Written by:
Hertzig LL, Iwaszko MR, Rangel LJ, Patterson DE, Gettman MT, Krambeck AE. Are you the author?
Department of Urology, Mayo Clinic, Rochester, MN.
Reference: J Urol. 2012 Dec 7. pii: S0022-5347(12)05816-8.
doi: 10.1016/j.juro.2012.12.003
PubMed Abstract
PMID: 23228383
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