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Urolithiasis after ileal conduit urinary diversion: a comparison of minimally invasive therapies.
J Urol. 2013 Jun; 189(6):2152-7.JU

Abstract

PURPOSE

We report our experience with ureteroscopy, percutaneous nephrolithotomy and shock wave lithotripsy for symptomatic stone disease in patients with ileal conduit urinary diversion.

MATERIALS AND METHODS

We retrospectively reviewed the charts of all patients treated with cystectomy and ileal conduit urinary diversion from 1982 to June 2010 in whom urolithiasis subsequently developed.

RESULTS

We identified 77 patients with urolithiasis requiring surgical intervention after ileal conduit urinary diversion. Average age at treatment was 62.5 years (range 30 to 82). Mean followup was 7.1 years (range 0.1 to 24.3). The primary therapy mode was percutaneous nephrolithotomy in 48 patients (62.3%), extracorporeal shock wave lithotripsy in 20 (26.0%) and ureteroscopy in 9 (11.6%). Average stone size was greater in the nephrolithotomy group than in the ureteroscopy and lithotripsy groups (2.1 vs 0.9 and 1.0 cm, respectively, p <0.0001). Total complication rates were similar, including 29% for nephrolithotomy, 30% for lithotripsy and 33% for ureteroscopy (p = 0.9). The incidence of stone-free status was greater in the nephrolithotomy cohort than in the ureteroscopy and shock wave lithotripsy cohorts (83.3% vs 33.3% and 30%, respectively, p <0.0001). The re-treatment rate did not significantly differ among the groups with 66.7% of the ureteroscopy group requiring subsequent procedures compared to 29.2% of the nephrolithotomy and 45% of the lithotripsy groups (p = 0.08). The change in the mean preoperative and current calculated glomerular filtration rate did not significantly differ among the 3 treatment groups.

CONCLUSIONS

Treatment for urolithiasis in patients with urinary diversion is associated with high re-treatment and complication rates. Percutaneous nephrolithotomy achieves a better stone-free outcome than ureteroscopy or shock wave lithotripsy. However, there is no difference in ancillary procedures or complication rates among the 3 treatment modalities.

Authors+Show Affiliations

Department of Urology and Division of Biostatistics (LJR), Mayo Clinic, Rochester, Minnesota 55905, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23228383

Citation

Hertzig, Lindsay L., et al. "Urolithiasis After Ileal Conduit Urinary Diversion: a Comparison of Minimally Invasive Therapies." The Journal of Urology, vol. 189, no. 6, 2013, pp. 2152-7.
Hertzig LL, Iwaszko MR, Rangel LJ, et al. Urolithiasis after ileal conduit urinary diversion: a comparison of minimally invasive therapies. J Urol. 2013;189(6):2152-7.
Hertzig, L. L., Iwaszko, M. R., Rangel, L. J., Patterson, D. E., Gettman, M. T., & Krambeck, A. E. (2013). Urolithiasis after ileal conduit urinary diversion: a comparison of minimally invasive therapies. The Journal of Urology, 189(6), 2152-7. https://doi.org/10.1016/j.juro.2012.12.003
Hertzig LL, et al. Urolithiasis After Ileal Conduit Urinary Diversion: a Comparison of Minimally Invasive Therapies. J Urol. 2013;189(6):2152-7. PubMed PMID: 23228383.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Urolithiasis after ileal conduit urinary diversion: a comparison of minimally invasive therapies. AU - Hertzig,Lindsay L, AU - Iwaszko,Markian R, AU - Rangel,Laureano J, AU - Patterson,David E, AU - Gettman,Matthew T, AU - Krambeck,Amy E, Y1 - 2012/12/07/ PY - 2012/12/05/accepted PY - 2012/12/12/entrez PY - 2012/12/12/pubmed PY - 2013/7/19/medline SP - 2152 EP - 7 JF - The Journal of urology JO - J. Urol. VL - 189 IS - 6 N2 - PURPOSE: We report our experience with ureteroscopy, percutaneous nephrolithotomy and shock wave lithotripsy for symptomatic stone disease in patients with ileal conduit urinary diversion. MATERIALS AND METHODS: We retrospectively reviewed the charts of all patients treated with cystectomy and ileal conduit urinary diversion from 1982 to June 2010 in whom urolithiasis subsequently developed. RESULTS: We identified 77 patients with urolithiasis requiring surgical intervention after ileal conduit urinary diversion. Average age at treatment was 62.5 years (range 30 to 82). Mean followup was 7.1 years (range 0.1 to 24.3). The primary therapy mode was percutaneous nephrolithotomy in 48 patients (62.3%), extracorporeal shock wave lithotripsy in 20 (26.0%) and ureteroscopy in 9 (11.6%). Average stone size was greater in the nephrolithotomy group than in the ureteroscopy and lithotripsy groups (2.1 vs 0.9 and 1.0 cm, respectively, p <0.0001). Total complication rates were similar, including 29% for nephrolithotomy, 30% for lithotripsy and 33% for ureteroscopy (p = 0.9). The incidence of stone-free status was greater in the nephrolithotomy cohort than in the ureteroscopy and shock wave lithotripsy cohorts (83.3% vs 33.3% and 30%, respectively, p <0.0001). The re-treatment rate did not significantly differ among the groups with 66.7% of the ureteroscopy group requiring subsequent procedures compared to 29.2% of the nephrolithotomy and 45% of the lithotripsy groups (p = 0.08). The change in the mean preoperative and current calculated glomerular filtration rate did not significantly differ among the 3 treatment groups. CONCLUSIONS: Treatment for urolithiasis in patients with urinary diversion is associated with high re-treatment and complication rates. Percutaneous nephrolithotomy achieves a better stone-free outcome than ureteroscopy or shock wave lithotripsy. However, there is no difference in ancillary procedures or complication rates among the 3 treatment modalities. SN - 1527-3792 UR - https://www.unboundmedicine.com/medline/citation/23228383/Urolithiasis_after_ileal_conduit_urinary_diversion:_a_comparison_of_minimally_invasive_therapies_ L2 - https://www.jurology.com/doi/full/10.1016/j.juro.2012.12.003?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -