Endourologic strategies for a minimally invasive management of urinary tract stones in patients with urinary diversion

Abstract

ObjectiveTo present our experience in minimally invasive management of urinary tract stones in patients with urinary diversion.Materials and MethodsWe retrospectively reviewed 26 patients with urinary tract stones after cystectomy and urinary diversion. The types of urinary diversion were ileal conduit, colon conduit, ileal orthotopic neobladder in 19, 4, and 3 patients, respectively. At postoperative days 2, a plain KUB and urinary ultrasonography were performed in order to assess stone fragmentation or hydronephrosis. According to postoperative imaging, stone free rate (SFR) was defined as complete absence of fragments or residual stones less than 4mm.Results19 patients were treated with minimally invasive percutaneous lithotripsy (MPCNL) and 2 patients required second-look MPCNL. Anterograde flexible ureteroscopy was performed in 2 patients, while in 2 patients a combined anterograde and retrograde approach was required. Three reservoir stones were treated by transurethral neo-bladder lithotripsy. Postoperative significant complications occurred in 2 patients (7.7%). The highest percentage of stone composition was struvite, as a result of chronic urinary tract infection (UTI). SFR was 88.5% (23 of 26).ConclusionsOur experience showed that MPCNL is a safe and effective treatment modality with little morbidity for renal and upper ureteral stones in patients with urinary diversion. For middle and lower ureteral stones, an anterograde approach could be also considered as a first line treatment, but a combined anterograde and retrograde approach was required when the anterograde access alone cannot provide acceptable results.

REPLY TO THE AUTHORS: Re: Endourologic strategies for a minimally invasive management of urinary tract stones in patients with urinary diversion

“…We appreciated the valuable comments on our recent published article in the International Braz J Urol ( 1 , 2 ). We agree with the commentary, to our knowledge, these studies have shown that the complicated patients with lower tract stone were treated by endoscopic management.…”

Re: Endourologic strategies for a minimally invasive management of urinary tract stones in patients with urinary diversion

“…We read with interest the recent paper by Zhong et al examining the variety of endourological strategies available for the management of urinary tract stone disease in patients following urinary diversion ( 1 ).…”

“…The authors report a retrospective study involving 26 patients who underwent urinary diversion and who subsequently presented with stone related problems and allude to the variety of techniques available ( 1 ).…”

“…Specific to the lower tract it is stated that 3 patients underwent orthotopic neobladder surgery and were subsequently treated for vesical calculi with neobladder lithotripsy and in select cases a second look procedure was performed 3-5 days later ( 1 ).…”

“…The authors list the treatment modalities mentioned: PCNL, SWL, Percutaneous antegrade and retrograde ureteroscopy and open removal ( 1 ) but should acknowledge that in the diverted patient a variety of hybrid techniques have evolved to permit safe lower tract stone removal. Specific to the neuropathic patient with an ablated urethra and Mitrofanoff bladder laser cystolithotripsy with a flexible cystoscope (Leighton Technique) allowing complete stone removal in one sitting has been described ( 2 ).…”