Hertzig LL et al, 2012: Urolithiasis after ileal conduit urinary diversion: a comparison of minimally invasive therapies
Hertzig LL, Iwaszko MR, Rangel LJ, Patterson DE, Gettman MT, Krambeck AE
Department of Urology, Mayo Clinic, Rochester, MN.
Abstract
PURPOSE: We report our experience with ureteroscopy, percutaneous nephrolithotomy (PCNL), and shock wave lithotripsy (SWL) for the treatment of symptomatic stone disease in patients with ileal conduit urinary diversions.
MATERIALS AND METHODS: Retrospective chart review of all patients treated with cystectomy and ileal conduit urinary diversion from 1982 to June of 2010 who subsequently developed urolithiasis was performed.
RESULTS: We identified 77 patients who developed urolithiasis requiring surgical intervention after ileal conduit urinary diversion. Average treatment age was 62.5 years (30-82). Mean follow-up was 7.1 years (0.1-24.3). Primary mode of therapy was percutaneous nephrolithotomy (PCNL) in 48 (62.3%), extracorporeal shock wave lithotripsy (SWL) in 20 (26.0%) and ureteroscopy in 9 (11.6%), patients. Average stone size was larger for PCNL (2.1 cm) compared to ureteroscopy (0.9 cm) or SWL (1.0 cm), (p<0.0001). Total complication rates were similar between groups: 29% PCNL, 30% SWL, and 33% ureteroscopy, (p=0.9). Stone-free status was higher in the PCNL (83.3%) cohort compared to the ureteroscopy (33.3%) or SWL (30%), (p<0.0001). The retreatment rate was not significantly different between groups with 66.7% of the ureteroscopy group requiring subsequent procedures compared to 29.2% of PCNL and 45% of SWL (p=0.08). Change in mean preoperative and current calculated glomerular filtration rate was not significantly different amongst the three treatment groups.
CONCLUSIONS: Treatment of urolithiasis in patients with urinary diversion is associated with high retreatment and complication rates. PCNL achieves better stone-free outcomes than ureteroscopy or SWL; however, there was no difference in ancillary procedures or complication rates between the three treatment modalities.
J Urol. 2012 Dec 7. doi:pii: S0022-5347(12)05816-8. 10.1016/j.juro.2012.12.003. [Epub ahead of print]
PMID: 23228383[PubMed - as supplied by publisher]
Comments 1
Basically this is just a "me to" paper with little useful information. Only 77 patients in 28 years show that this is a rare event in the author's experience. They state: "Prior reports described stone-free rates ranging from 25-92% when SWL was used to treat stones in patients with urinary diversions." But unfortunately they do not give a comment how the good results may be achieved. The complication rate was not statistically significant different, probably due to the small number of cases. But the data show that an impeded passage of fragments can be a major problem after ESWL and that patient selection is very important.
Peter Alken