Long-Term Incidence and Risks for Recurrent Stones Following Contemporary Management of Upper Tract Calculi in Patients with a Urinary Diversion

Abstract

Contemporary management of upper tract calculi in patients with a urinary diversion is associated with a high recurrence rate, especially among those with recurrent bacteriuria, regardless of whether the patient is initially rendered stone-free. Continued close surveillance and antibiotic prophylaxis seem to be essential in this high risk patient population.

Management of urolithiasis in patients after urinary diversions

“…A series of 800 patients with Mainz pouch diversions, with a median follow‐up of 7.6 years, showed a 10.8% incidence of stones in reservoirs with an intussuscepted ileal nipple and 5.6% in reservoirs with an appendiceal stoma [4]. The incidence of upper tract stones in patients with urinary diversions is comparable with the general population [1,5–8].…”

Predictive Factors for Percutaneous Nephrolithotomy Outcomes in Neurogenic Bladder Population

“…[1][2][3][4][5][6] Risk factors for urolithiasis include recurrent urinary tract infections, urinary stasis, and hypercalciuria associated with prolonged immobility. Urinary collecting system access is also difficult in this population because of altered body habitus, such as severe kyphoscoliosis and contractures, as well as urinary diversion.…”

Treatment of Upper Urinary Lithiasis in Patients Who Have Undergone Urinary Diversion

“…In a longitudinal series published in 1996, Cohen et al [25] followed 25 patients with urinary diversion for a minimum of 12 months after SWL and/ or PCNL for upper urinary tract calculi. A total of eight patients (32%) had recurrent stone disease at a mean of 27.0 months (range 18-61 months) after treatment.…”

“…Thus, these high-risk patients should be carefully monitored using follow-up imaging, and also, assessed for the presence of a urinary tract infection, which has been identified as one of the leading causes of stone disease in this population [25]. In addition to addressing any metabolic needs within this patient population, such as the use of potassium citrate or bicarbonate in acidotic patients, the performance of regular pouch irrigation to ensure complete emptying also is instrumental to the prevention of recurrent nephrolithiasis.…”