Large bifid ureteric calculus in a patient with an ileal conduit

Abstract

Urinary diversion after extirpative surgery of the bladder is done by various methods. Conduit urinary diversion is the most commonly practiced method of urinary diversion. It is relatively easy to perform and has a lower complication rate than other forms of diversion, e.g., orthotopic neobladder and continent cutaneous urinary diversion. Urolithiasis is a known and common complication of urinary diversion. Upper tract calculi in these cases often manifest symptomatically as occurs in the general population. Stones in the conduit can have a variable clinical presentation. Asymptomatic presentation is also noted in a few cases. We report a case of a large silent bifid ureteric calculus within an ileal conduit in a woman who had undergone urinary diversion 32 years earlier. Plain X-ray of the abdomen is the only investigation necessary to rule out urinary lithiasis in those who have had urinary diversion for a long time. This simple tool can diagnose the condition well in advance and aid in planning the management of this condition.

Forgotten DJ Stent with a Large Calculus at Its Distal End in an Ileal Conduit Diversion

“…Urinary diversion is an essential part in the management of patients who undergo extirpative surgery of the bladder like radical cystectomy [ 3 ]. Even in this current era of continent urinary diversion and neobladder formation, ileal conduit is still considered a safe procedure and the gold standard to which newer forms of urinary diversion are compared.…”

“…The various complications manifest at different times, and these patients require close surveillance for even decades after the urinary diversion [ 2 ]. One of the long term complications noted after urinary diversion is urolithiasis and the incidence varies from 4.9% to 15.3% [ 3 ]. The majority of these stones are composed of calcium, magnesium, and ammonium phosphate and occur mostly as a result of metabolic acidosis induced hypercalciuria, stomal stenosis, structural and neuromechanial alteration induced urinary stasis, and urinary tract infection with urea splitting organism or due to presence of foreign bodies such as stapler or nonabsorbable suture [ 1 , 3 ].…”

“…Stone formation in such conduit is a known long term complication [ 1 , 2 ]. A prolonged in situ presence of a stent may also lead to encrustation and stone formation [ 3 ]; however, it has never been reported in this group of patients with conduit who usually remain under close surveillance.…”

Follow the Stream: Imaging of Urinary Diversions

“…Urolithiasis.-Urinary tract calculi formation is a common long-term complication of urinary diversion procedures, and patients with urinary diversions are at a higher risk of urinary calculi (36). Thus, it is important for radiologists to evaluate all patients with urinary diversion for calculi.…”

Symptomatic Distal Ureteral Stone in an Ileal Ureter: Treatment by Combined Supine Ureteroscopy and Mini Percutaneous Nephrolithotomy

“…Symptoms of the patients may vary from abdominal pain, recurrent urinary tract infection, and hematuria to completely asymptomatic patients wherein urolithiasis is diagnosed coincidentally. 2 Stone formation in urinary diversion is a complex process and yet not fully understood. Treatment of urolithiasis in patients with intestinal urinary diversion was previously described using shockwave lithotripsy (SWL), antegrade or retrograde endoscopic techniques (ureteroscopy [URS]), percutaneous nephrolithotomy (PCNL), and in several cases open surgery was performed.…”