Urolithiasis after ileal conduit urinary diversion: A comparison of minimally invasive therapies

Lindsay L. Hertzig, Markian R. Iwaszko, Laureano J. Rangel, David E. Patterson, Matthew T. Gettman, Amy Krambeck

Research output: Contribution to journalReview article

14 Citations (Scopus)

Abstract

Purpose: We report our experience with ureteroscopy, percutaneous nephrolithotomy and shock wave lithotripsy for symptomatic stone disease in patients with ileal conduit urinary diversion. Materials and Methods: We retrospectively reviewed the charts of all patients treated with cystectomy and ileal conduit urinary diversion from 1982 to June 2010 in whom urolithiasis subsequently developed. Results: We identified 77 patients with urolithiasis requiring surgical intervention after ileal conduit urinary diversion. Average age at treatment was 62.5 years (range 30 to 82). Mean followup was 7.1 years (range 0.1 to 24.3). The primary therapy mode was percutaneous nephrolithotomy in 48 patients (62.3%), extracorporeal shock wave lithotripsy in 20 (26.0%) and ureteroscopy in 9 (11.6%). Average stone size was greater in the nephrolithotomy group than in the ureteroscopy and lithotripsy groups (2.1 vs 0.9 and 1.0 cm, respectively, p <0.0001). Total complication rates were similar, including 29% for nephrolithotomy, 30% for lithotripsy and 33% for ureteroscopy (p = 0.9). The incidence of stone-free status was greater in the nephrolithotomy cohort than in the ureteroscopy and shock wave lithotripsy cohorts (83.3% vs 33.3% and 30%, respectively, p <0.0001). The re-treatment rate did not significantly differ among the groups with 66.7% of the ureteroscopy group requiring subsequent procedures compared to 29.2% of the nephrolithotomy and 45% of the lithotripsy groups (p = 0.08). The change in the mean preoperative and current calculated glomerular filtration rate did not significantly differ among the 3 treatment groups. Conclusions: Treatment for urolithiasis in patients with urinary diversion is associated with high re-treatment and complication rates. Percutaneous nephrolithotomy achieves a better stone-free outcome than ureteroscopy or shock wave lithotripsy. However, there is no difference in ancillary procedures or complication rates among the 3 treatment modalities.

Original languageEnglish (US)
Pages (from-to)2152-2157
Number of pages6
JournalJournal of Urology
Volume189
Issue number6
DOIs
StatePublished - Jun 2013
Externally publishedYes

Fingerprint

Ureteroscopy
Urinary Diversion
Urolithiasis
Lithotripsy
Percutaneous Nephrostomy
Therapeutics
Cystectomy
Glomerular Filtration Rate
Incidence

Keywords

  • cystectomy
  • lithotripsy
  • urinary bladder
  • urinary diversion
  • urolithiasis

ASJC Scopus subject areas

  • Urology

Cite this

Urolithiasis after ileal conduit urinary diversion : A comparison of minimally invasive therapies. / Hertzig, Lindsay L.; Iwaszko, Markian R.; Rangel, Laureano J.; Patterson, David E.; Gettman, Matthew T.; Krambeck, Amy.

In: Journal of Urology, Vol. 189, No. 6, 06.2013, p. 2152-2157.

Research output: Contribution to journalReview article

Hertzig, Lindsay L. ; Iwaszko, Markian R. ; Rangel, Laureano J. ; Patterson, David E. ; Gettman, Matthew T. ; Krambeck, Amy. / Urolithiasis after ileal conduit urinary diversion : A comparison of minimally invasive therapies. In: Journal of Urology. 2013 ; Vol. 189, No. 6. pp. 2152-2157.
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abstract = "Purpose: We report our experience with ureteroscopy, percutaneous nephrolithotomy and shock wave lithotripsy for symptomatic stone disease in patients with ileal conduit urinary diversion. Materials and Methods: We retrospectively reviewed the charts of all patients treated with cystectomy and ileal conduit urinary diversion from 1982 to June 2010 in whom urolithiasis subsequently developed. Results: We identified 77 patients with urolithiasis requiring surgical intervention after ileal conduit urinary diversion. Average age at treatment was 62.5 years (range 30 to 82). Mean followup was 7.1 years (range 0.1 to 24.3). The primary therapy mode was percutaneous nephrolithotomy in 48 patients (62.3{\%}), extracorporeal shock wave lithotripsy in 20 (26.0{\%}) and ureteroscopy in 9 (11.6{\%}). Average stone size was greater in the nephrolithotomy group than in the ureteroscopy and lithotripsy groups (2.1 vs 0.9 and 1.0 cm, respectively, p <0.0001). Total complication rates were similar, including 29{\%} for nephrolithotomy, 30{\%} for lithotripsy and 33{\%} for ureteroscopy (p = 0.9). The incidence of stone-free status was greater in the nephrolithotomy cohort than in the ureteroscopy and shock wave lithotripsy cohorts (83.3{\%} vs 33.3{\%} and 30{\%}, respectively, p <0.0001). The re-treatment rate did not significantly differ among the groups with 66.7{\%} of the ureteroscopy group requiring subsequent procedures compared to 29.2{\%} of the nephrolithotomy and 45{\%} of the lithotripsy groups (p = 0.08). The change in the mean preoperative and current calculated glomerular filtration rate did not significantly differ among the 3 treatment groups. Conclusions: Treatment for urolithiasis in patients with urinary diversion is associated with high re-treatment and complication rates. Percutaneous nephrolithotomy achieves a better stone-free outcome than ureteroscopy or shock wave lithotripsy. However, there is no difference in ancillary procedures or complication rates among the 3 treatment modalities.",
keywords = "cystectomy, lithotripsy, urinary bladder, urinary diversion, urolithiasis",
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T1 - Urolithiasis after ileal conduit urinary diversion

T2 - A comparison of minimally invasive therapies

AU - Hertzig, Lindsay L.

AU - Iwaszko, Markian R.

AU - Rangel, Laureano J.

AU - Patterson, David E.

AU - Gettman, Matthew T.

AU - Krambeck, Amy

PY - 2013/6

Y1 - 2013/6

N2 - Purpose: We report our experience with ureteroscopy, percutaneous nephrolithotomy and shock wave lithotripsy for symptomatic stone disease in patients with ileal conduit urinary diversion. Materials and Methods: We retrospectively reviewed the charts of all patients treated with cystectomy and ileal conduit urinary diversion from 1982 to June 2010 in whom urolithiasis subsequently developed. Results: We identified 77 patients with urolithiasis requiring surgical intervention after ileal conduit urinary diversion. Average age at treatment was 62.5 years (range 30 to 82). Mean followup was 7.1 years (range 0.1 to 24.3). The primary therapy mode was percutaneous nephrolithotomy in 48 patients (62.3%), extracorporeal shock wave lithotripsy in 20 (26.0%) and ureteroscopy in 9 (11.6%). Average stone size was greater in the nephrolithotomy group than in the ureteroscopy and lithotripsy groups (2.1 vs 0.9 and 1.0 cm, respectively, p <0.0001). Total complication rates were similar, including 29% for nephrolithotomy, 30% for lithotripsy and 33% for ureteroscopy (p = 0.9). The incidence of stone-free status was greater in the nephrolithotomy cohort than in the ureteroscopy and shock wave lithotripsy cohorts (83.3% vs 33.3% and 30%, respectively, p <0.0001). The re-treatment rate did not significantly differ among the groups with 66.7% of the ureteroscopy group requiring subsequent procedures compared to 29.2% of the nephrolithotomy and 45% of the lithotripsy groups (p = 0.08). The change in the mean preoperative and current calculated glomerular filtration rate did not significantly differ among the 3 treatment groups. Conclusions: Treatment for urolithiasis in patients with urinary diversion is associated with high re-treatment and complication rates. Percutaneous nephrolithotomy achieves a better stone-free outcome than ureteroscopy or shock wave lithotripsy. However, there is no difference in ancillary procedures or complication rates among the 3 treatment modalities.

AB - Purpose: We report our experience with ureteroscopy, percutaneous nephrolithotomy and shock wave lithotripsy for symptomatic stone disease in patients with ileal conduit urinary diversion. Materials and Methods: We retrospectively reviewed the charts of all patients treated with cystectomy and ileal conduit urinary diversion from 1982 to June 2010 in whom urolithiasis subsequently developed. Results: We identified 77 patients with urolithiasis requiring surgical intervention after ileal conduit urinary diversion. Average age at treatment was 62.5 years (range 30 to 82). Mean followup was 7.1 years (range 0.1 to 24.3). The primary therapy mode was percutaneous nephrolithotomy in 48 patients (62.3%), extracorporeal shock wave lithotripsy in 20 (26.0%) and ureteroscopy in 9 (11.6%). Average stone size was greater in the nephrolithotomy group than in the ureteroscopy and lithotripsy groups (2.1 vs 0.9 and 1.0 cm, respectively, p <0.0001). Total complication rates were similar, including 29% for nephrolithotomy, 30% for lithotripsy and 33% for ureteroscopy (p = 0.9). The incidence of stone-free status was greater in the nephrolithotomy cohort than in the ureteroscopy and shock wave lithotripsy cohorts (83.3% vs 33.3% and 30%, respectively, p <0.0001). The re-treatment rate did not significantly differ among the groups with 66.7% of the ureteroscopy group requiring subsequent procedures compared to 29.2% of the nephrolithotomy and 45% of the lithotripsy groups (p = 0.08). The change in the mean preoperative and current calculated glomerular filtration rate did not significantly differ among the 3 treatment groups. Conclusions: Treatment for urolithiasis in patients with urinary diversion is associated with high re-treatment and complication rates. Percutaneous nephrolithotomy achieves a better stone-free outcome than ureteroscopy or shock wave lithotripsy. However, there is no difference in ancillary procedures or complication rates among the 3 treatment modalities.

KW - cystectomy

KW - lithotripsy

KW - urinary bladder

KW - urinary diversion

KW - urolithiasis

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