Percutaneous treatment of large upper tract stones after urinary diversion.
OBJECTIVE
To present our experience in percutaneous management of large upper tract stones after urinary diversion.


METHODS
From October 1984 to March 2005, 20 percutaneous nephrolithotomy and 4 antegrade ureteroscopy procedures were performed in 17 men and 7 women, with a mean age of 53.5 years. The urinary diversions were an ileal W neobladder, hemi-Kock pouch, ileal conduit, and rectal bladder in 10, 7, 4, and 3 patients, respectively. The median interval between diversion and stone management was 1.5 years. Success was defined as a stone-free, nonobstructed renal unit at 3 months after the intervention. Follow-up was performed every 6 months with intravenous urography or noncontrast computed tomography for diagnosis of stone recurrence and evaluation of renal morphology.


RESULTS
Renal punctures were guided with ultrasonography in 18 patients (75%) and fluoroscopy in 6 patients. One intraoperative complication (4.16%) and two postoperative complications (8.3%) occurred. All patients with ureteral stones became stone free after one procedure. Auxiliary procedures were needed in 5 patients after percutaneous nephrolithotomy; 2 patients required a second session and 3 needed extracorporeal shock wave lithotripsy. The overall success rate was 87.5% (21 patients). One patient with treatment failure underwent open surgery, and two with small residual fragments were followed up. Long-term follow-up data were available for 15 patients. The stone recurrence rate was 33.3% (5 patients) after a median follow-up of 40 months (range 14 to 132). Recurrent stones were treated with extracorporeal shock wave lithotripsy.


CONCLUSIONS
The results of our study have demonstrated that percutaneous treatment of large upper tract stones after urinary diversion offers a high success rate with minimal morbidity. However, regular follow-up after treatment is recommended.
el-Nahas
Ahmed R
AR
Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Eraky
Ibrahim
I
el-Assmy
Ahmed M
AM
Shoma
Ahmed M
AM
el-Kenawy
Mahmoud R
MR
Abdel-Latif
Mohamed
M
Mosbah
Ahmed
A
Abol-Enein
Hassan
H
Shaaban
Atallah A
AA
Mohsen
Tarek
T
el-Kappany
Hamdy A
HA
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000209:etiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D014514:Ureteral Calculi / Q000209:etiology* / Q000628:therapy*; D018666:Ureteroscopy; D014547:Urinary Diversion / Q000009:adverse effects*