title: Percutaneous nephrolithotripsy in patients with urinary diversions: a case-control comparison of perioperative outcomes.
abstract: OBJECTIVE
  To compare the operative techniques and perioperative outcomes of patients with urinary intestinal diversions undergoing percutaneous nephrolithotripsy (PCNL), to a control cohort of patients without diversions.
  
  
  METHODS
  The medical records of all patients who were treated with PCNL from 1990 to 2009 were retrospectively reviewed. Each urinary diversion patient's first PCNL was age-matched with four controls who were undergoing PCNL. The perioperative outcomes were compared between the diversion and control cohorts.
  
  
  RESULTS
  Twenty-five patients with a urinary diversion who had undergone 33 PCNLs were identified. The mean age was 49.3 (8-85) years for the diversion group and 48.9 (4-84) for the control group. Urinary tract infection (64% vs 15% patients, P<0.0001), neurologic disease (64% vs 2%, P<0.0001), previous procedure for the same calculus (24% vs 4%, P=0.0004), urinary tract abnormalities (56% vs 14%, P<0.0001), solitary kidney (20% vs 3%, P=0.0081), and struvite stones (80% vs 12.5%, P=0.0006) were more commonly observed in the diversion group. Percutaneous access gained by a radiologist (40% vs 0%, P<0.0001), second-look nephroscopy (36% vs 16%, P=0.0466), and an increase in the frequency of fever or sepsis (8% vs 0%, P=0.0387) were identified more frequently in the diversion group.
  
  
  CONCLUSIONS
  Patients with upper tract calculi and urinary diversions are challenging to the endourologist because of anatomic factors that can make percutaneous access more difficult; ultrasonography-guided access can be helpful in this setting. Patients with urinary diversions can be treated as safely and effectively by PCNL as nondiverted patients.
authors.affiliation: Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Fernandez
authors.forename: Kirsten
authors.initials: K
authors.lastname: Foell
authors.forename: Linda
authors.initials: L
authors.lastname: Nott
authors.forename: John D
authors.initials: JD
authors.lastname: Denstedt
authors.forename: Hassan
authors.initials: H
authors.lastname: Razvi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000150:complications / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D019990:Perioperative Care; D016896:Treatment Outcome; D014547:Urinary Diversion; D055815:Young Adult