title: Urolithiasis after ileal conduit urinary diversion: a comparison of minimally invasive therapies.
abstract: OBJECTIVE
  We report our experience with ureteroscopy, percutaneous nephrolithotomy and shock wave lithotripsy for symptomatic stone disease in patients with ileal conduit urinary diversion.
  
  
  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.
authors.affiliation: Department of Urology and Division of Biostatistics (LJR), Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Lindsay L
authors.initials: LL
authors.lastname: Hertzig
authors.forename: Markian R
authors.initials: MR
authors.lastname: Iwaszko
authors.forename: Laureano J
authors.initials: LJ
authors.lastname: Rangel
authors.forename: David E
authors.initials: DE
authors.lastname: Patterson
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Gettman
authors.forename: Amy E
authors.initials: AE
authors.lastname: Krambeck
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015653:Cystectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007669:Kidney Calculi / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000379:methods*; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery; D014547:Urinary Diversion / Q000009:adverse effects* / Q000379:methods; D052878:Urolithiasis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy