1306 COMPARISON OF THE INCIDENCE AND COMPOSITION OF UPPER TRACT AND LOWER TRACT CALCULI IN PATIENTS WHO HAVE UNDERGONE URINARY DIVERSION

Article Outline

• INTRODUCTION AND OBJECTIVES
• METHODS
• RESULTS
• CONCLUSIONS
• Copyright

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INTRODUCTION AND OBJECTIVES 

Patients who have undergone urinary diversion including ileal conduit, continent diversions and augmentation cystoplasty can develop calculi. However, the prevalence and stone composition is underreported in the urologic literature. We evaluated the incidence of procedures performed for stones in patients who have undergone urinary diversions, as well as the differences in stone composition between the upper and lower urinary tract.

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METHODS 

Between January 1998 and March 2009, we performed a retrospective analysis of all patients who have undergone urinary diversion, including continent cutaneous diversion, neobladder, augmentation cystoplasty, and ileal conduit, which then had subsequent procedures for stone disease. Stone composition and location for each patient was recorded and compared between the groups.

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RESULTS 

1,285 patients underwent neobladder, continent cutaneous, and ileal conduit diversion at our institution. A total of 35 patients underwent 43 stone procedures following urinary diversion. 9 additional patients who underwent augmentation cystoplasty underwent 12 stone procedures. There was a significant increase in patients requiring procedures for stone formation in those who underwent a continent diversion (7.3%) as opposed to an ileal conduit (1.5%) [p<0.001]. 41 of the stone procedures (74.5%) were performed on patients with continent diversions, in which the majority were found in the reservoir. In the entire cohort, 52% of the stones were metabolic, 38% were infectious, and 10% were mixed. Of the 25 procedures performed for upper tract stones, 14 (56%) were metabolic. In patients with continent urinary diversions with lower tract stones, 45% were metabolic stones.

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CONCLUSIONS 

Patients with continent urinary diversions are more likely to require a treatment for stones when compared to other types of urinary diversion. Stones formed in the setting of urinary diversion have traditionally been thought to be infectious in nature. However, our data demonstrated that, as a group, patients with urinary diversion are more likely to form metabolic stones. Upper tract stones in all types of urinary diversion are more often metabolic. It is only in the patients with continent reservoir diversions that we observed slight predominance of infectious over metabolic stones, at 55% and 45%, respectively. These findings suggest the importance of performing an appropriate metabolic evaluation and regular imaging in patients who form stones following urinary diversion.