Urinary tract stone surgery in patients with urinary diversion and vesicostomy: a single center experience

Year 2021, , 78 - 83, 21.01.2021

Kubilay Sarıkaya , Çağri Şenocak , Fahri Erkan Sadioğlu , Mehmet Çiftçi Ömer Faruk Bozkurt

https://doi.org/10.32322/jhsm.843304

Abstract

Objective:
To report our experience in percutaneous nephrolithotomy and endoscopic urinary tract stone surgery in patients with urinary diversion and vesicostomy.
Materials and Methods:
Data of 21 patients with urinary diversion or vesicostomy who underwent surgery for urinary tract stones in our clinic between January 2008 and January 2020 were retrospectively analyzed. Eight patients (38%) underwent percutaneous nephrolithotomy, 2 patients (9.5%) underwent antegrade flexible ureteroscopy, 4 patients (19.0%) underwent retrograde semi-rigid or flexible ureteroscopy, 5 patients (23.8%) underwent retrograde pouch lithotripsy and 2 patients (9.5%) underwent percutaneous cystolithotripsy with vesicostomy tract entrance.Preoperative and postoperative data of the patients were evaluated.
Results:
The male to female ratio was 16/5. The mean age of the patients was 54.6 ± 10.1 years and mean preoperative stone diameter was 2.8 ± 4.5 cm. It was determined that 14 patients (66.6%) had ileal conduit (Bricker anastomosis), 5 patients (23.8%) had ureterocutaneostomy, and 2 patients (9.5%) had vesicostomy. Stone-free rate was 85.7% after single session of treatment. In the postoperative period, febrile urinary tract infection was observed in 4 (19.0%) patients, urinary system obstruction secondary to stone in 3 (14.2%) patients and anastomotic leakage in 1 (4.7%) patient.
Conclusion:
Percutaneous nephrolithotomy, antegrade ureterorenoscopy, retrograde ureterorenoscopy and vesicostomy entry cystolithotripsy are highly effective and safe methods in patients with urinary diversion and vesicostomy. The most important factors affecting the success are the experience of surgical team that can apply procedural options together with careful preoperative preparation and correct instrumentation.

Keywords

Urinary diversion, Stone formation, Stone surgery

References

• Simon J: Extrophia vesicae (absence of the anterior walls of the bladder and pubic abdominal parietes); operation for directing the orifices of the ureters into the rectum; temporary success; subsequent death; autopsy. Lancet 1852; 2: 568.
• Urh A, Soliman PT, Schmeler KM, et al. Postoperative outcomes after continent versus incontinent urinary diversion at the time of pelvic exenteration for gynecologic malignancies. Gynecol Oncol 2013; 129: 580-5.
• Turk TM, Koleski FC, Albala DM. Incidence of urolithiasis in cystectomy patients after intestinal conduit or continent urinary diversion. World J Urol 1999; 17: 305–7.
• Ginsberg D, Huffman JL, Lieskovsky G, Boyd S, Skinner DG. Urinary tract stones: a complication of the Kock pouch continent urinary diversion. J Urol 1991; 145: 956–9.
• Arai Y, Kawakita M, Terachi T, et al. Long-term follow up of the Kock and Indiana pouch procedures. J Urol 1993; 150: 51–5.
• Ku JH, Jung TY, Lee JK, Park WH, Shim HB. Risk factors for urinary stone formation in men with spinal cord injury: a 17-year follow-up study. BJU Int 2006; 97: 790-3.
• Okhunov Z, Duty B, Smith AD, Okeke Z. Management of urolithiasis in patients after urinary diversions. BJU Int 2011; 108: 330–6.
• Fernandez A, Foell K, Nott L, Fernandez A. Percutaneous nephrolithotripsy in patients with urinary diversions: A case-control comparison of perioperative outcomes. J Endourol 2011; 25: 1615–8.
• Franzoni DF, Decter RM. Percutaneous vesicolithotomy: an alternative to open bladder surgery in patients with an impassable or surgically ablated urethra. J Urol 1999; 162: 777–8.
• Cohen TD, Streem SB, Lammert G. Long-term incidence and risks for recurrent stones following contemporary management of upper tract calculi in patients with a urinary diversion. J Urol1996; 155: 62–5.
• Delvecchio FC, Kou RL, Iselin CE, et al: Combined antegrade and retrograde endoscopic approach for management of urinary diversion-associated pathology. J Endourol 2000; 14: 251–6.
• Terai A, Arai Y, Kawakita M et al. Effect of urinary intestinal diversion on urinary risk factors for urolithiasis. J Urol 1995; 153: 37.
• Shimko MS, Tollefson MK, Umbreit EC, et al. Long-term complications of conduit urinary diversion. J Urol 2011; 185: 562.
• Beiko DT and Razvi H: Stones in urinary diversions: update on medical and surgical issues. Curr Opin Urol 2002; 12: 297.
• el-Nahas AR, Eraky I, el-Assmy AM, et al. Percutaneous treatment of large upper tract stones after urinary diversion. Urology 2006; 68: 500-4.
• Haselhuhn GD, Kropp KA, Keck RW, Selman SH. Photochemical ablation of intestinal mucosa for bladder augmentation. J Urol. 1994; 152: 2267-71.
• Cohen TD, Streem SB, and Lammert GK: Selective minimally invasive management of calculi in patients with urinary diversions. J Urol 1994; 152: 1091–4.
• Razvi HA, Martin TV, Sosa ER, et al. Endourologic management of complications of urinary intestinal diversion. AUA Update Series 11(lesson 22): 174 –179, 1996.
• Cass AS, Lee JY, Aliabadi. Extracorporeal shock wave lithotripsy and endoscopic management of renal calculi with urinary diversions. J Urol 1992; 148: 1123–5.
• El-Assmy A, El-Nahas AR, Mohsen T, et al. Extracorporeal shock wave lithotripsy of upper urinary tract calculi in patients with cystectomy and urinary diversion. Urology 2005; 66: 510-3.
• Madbouly K. Large orthotopic reservoir stone burden: Role of open surgery. Urol Ann 2010; 2: 96–9.
• Hertzig LL, Iwaszko MR, Rangel LJ, Patterson DE, Gettman MT, Krambeck AE. Urolithiasis after ileal conduit urinary diversion: a comparison of minimally invasive therapies. J Urol 2013; 189: 2152-7. .
• Zhong W, Yang B, He F, Wang L, Swami S, Zeng G. Surgical management of urolithiasis in patients after urinary diversion. PLoS One 2014; 31: 9.
• Desai M. Ultrasonography-guided punctures-with and without puncture guide. J Endourol 2009; 23: 1641–3.
• Singla N, Montie JE, Lee CT, Wolf JS Jr, Faerber GJ. Experience with 45 Consecutive Patients with Neobladders Undergoing Retrograde Ureteroscopy for Upper Tract Abnormalities. Urol Pract 2015; 2: 244-9.
• Li X, He Z, Wu K, Li SK, Zeng G. Chinese minimally invasive percutaneous nephrolithotomy: the Guangzhou experience. J Endourol 2009; 23: 1693–7.
• Yamamoto M, Kashiwai H, Hirayama A, et al. [Long-term follow-up of female tetraplegic patients with cutaneous vesicostomy]. Hinyokika Kiyo 1997; 43: 263-6.
• Ord J, Lunn D, Reynard J. Bladder management and risk of bladder stone formation in spinal cord injured patients. J Urol 2003; 170: 1734-7.