title: Use of nonabsorbable staples for urinary diversion: a step in the wrong direction.
abstract: BACKGROUND
  The use of bowel segments incorporated into the urinary tract is well established in urological surgery.
  
  
  OBJECTIVE
  To describe and compare the use of absorbable and nonabsorbable staples for creation of a urine reservoir after radical cystectomy.
  
  
  METHODS
  This review is based on a systematic Medline search assessing the period 1950-2010.
  
  
  RESULTS
  Use of the autosuture stapling device for the construction of the urinary diversion significantly reduces operating time. Johnson and Fuerst reported its use for the first time to construct a ureteroileocutaneous urinary diversion in 1973. However, many studies demonstrated that exposed metal staples represent a nidus for stone formation when they are in direct contact with urine, particularly in urinary diversions such as Kock pouch and ileal conduit. Stone formation has been attributed in part to the use of nonabsorbable artificial materials, such as metal staples and Marlex mesh, strictures of the pouch and accumulation of mucus. The treatment options for pouch calculi include observation for spontaneous passage, extracorporeal shockwave lithotripsy, percutaneous or endoscopic lithotripsy/lithotomy.
  
  
  CONCLUSIONS
  Historically, the mean time to stone formation with nonabsorbable material (staples, Marlex mesh) is 34 months. None of the studies on use of nonabsorbable staples in urinary diversion has such a long follow-up. Until further studies with more appropriate observation time are completed, the use of nonabsorbable staples for continent and noncontinent urinary diversion should be discouraged.
authors: Campus Bio-Medico, University of Rome, Rome, Italy. f.suriano @ unicampus.it
authors: Francesca
authors: F
authors: Suriano
authors: Siamak
authors: S
authors: Daneshmand
authors: Maurizio
authors: M
authors: Buscarini
mesh_terms: D020341:Absorbable Implants; D015653:Cystectomy / Q000295:instrumentation*; D006801:Humans; D017792:Surgical Stapling / Q000295:instrumentation*; D013537:Sutures; D001743:Urinary Bladder / Q000601:surgery; D014545:Urinary Calculi / Q000209:etiology; D014547:Urinary Diversion / Q000295:instrumentation*; D016476:Urinary Reservoirs, Continent; D013520:Urologic Surgical Procedures / Q000295:instrumentation*