Badalato GM et al, 2011: Treatment of upper urinary lithiasis in patients who have undergone urinary diversion.

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Badalato GM et al, 2011: Treatment of upper urinary lithiasis in patients who have undergone urinary...

Badalato GM et al, 2011: Treatment of upper urinary lithiasis in patients who have undergone urinary diversion.

Badalato GM, Cortes JA, Gupta M.

Department of Urology, Columbia University, New York, NY 10036, USA.

Abstract

Patients undergoing urinary diversion are at high risk for developing stone disease due to the metabolic and structural features intrinsic to the creation of a urinary reservoir. The utilization of shockwave lithotripsy as well as antegrade and retrograde endoscopic techniques in appropriately selected patients affords a relatively safe and effective means of stone removal. This review focuses on the etiology of stone formation in patients with urinary diversion and examines the most relevant and current reports on expulsive techniques and their associated outcomes for patients within this population who develop upper urinary tract calculi.

Curr Urol Rep. 2011 Apr;12(2):121-5. doi: 10.1007/s11934-011-0175-3

PMID: 21365236 [PubMed - in process]

Comment

This is a review article that summarizes literature data and aspects on stone removal in patients with urinary diversion. It is stated that ESWL has a central place in stone removal for these patients at least for stones with a diameter up to 20 mm. In this regard there is thus no different indication compared with patients who have a normal anatomy. The second favoured approach is stone removal by an antegrade percutaneous technique. It is of note that this group of patients usually have infection stones and that a complete clearance of all –even small fragments – is essential for prevention of future recurrences.

In my opinion when there is a nephrostomy in place, chemolysis is an adjunctive method that in combination with ESWL or other stone removing procedures can result in a clearance that is impossible to achieve with mechanical devices only. This approach is, however, not mentioned in the article.

Hans-Göran Tiselius