Okhunov Z et al, 2011: Management of urolithiasis in patients after urinary diversions
Okhunov Z, Duty B, Smith AD, Okeke Z
The Smith Institute for Urology, North Shore - Long Island Jewish Health System, New Hyde Park, New York, NY, USA
Abstract
What's known on the subject? and What does the study add? Patients undergoing urinary diversion are at increased risk of stone formation in the upper urinary tract and within the pouch. Several studies have reported wide ranging outcomes of the various surgical and non-surgical management options. In this article we reviewed risk factors, etiology, and outcomes of surgical and medical management of diversion-associated urolithiasis. A surgical management algorithm was developed based on the known literature to serve as a guide to treatment stones in these patients. The relative effectiveness of various preventive management strategies are reviewed and summarized. After urinary diversion patients are at increased risk of long-term complications, including stones of the upper urinary tract and reservoir or conduit. Advances in instrumentation and techniques have expanded treatment options, while minimizing morbidity. Minimally invasive treatment methods include shockwave lithotripsy, antegrade and retrograde ureteroscopic lithotripsy and percutaneous nephrolithotomy. Percutaneous and laparoscopic techniques are applicable to stones within urinary diversions. Medical management is crucial for avoiding recurrent stones in these patients.
© 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.
BJU Int. 2011 Aug;108(3):330-6. doi: 10.1111/j.1464-410X.2011.10194.x. Epub 2011 May 25
PMID: 21615672[PubMed - as supplied by publisher]
Comments 1
This article is a review of risk factors as well as management of urolithiasis encountered in patients with continent as well as incontinent urinary diversion. The difficulties associated with retrograde endoscopic procedures give ESWL the place as first line treatment for both kidney and ureteral stones. It is of note, however, that antibiotics need to be administered in order to avoid septic complications and that great care is necessary in patients with signs of obstruction.
Various other endoscopic procedures are also discussed in this article.
Hans-Göran Tiselius