Stones in urinary diversions: update on medical and surgical issues

Abstract

Purpose of review: Patients who undergo urinary tract diversion are at an increased risk of urolithiasis for various reasons. The purpose of this article is to provide an up-to-date summary of the progress that has been made in the pathogenesis, diagnosis and treatment of stones in patients with urinary diversions. Finally, we will provide recommendations for follow-up in patients with urinary diversions who develop urinary tract calculi.

Recent findings: In contemporary studies, the incidence of urolithiasis in patients with urinary diversion appears to be decreasing. Computed tomography scanning has been shown to be superior to ultrasound in the diagnosis of calculi in such patients. Endourological procedures have become the mainstay of therapy for stones in patients with urinary diversions. Since the introduction of extracorporeal shock wave lithotripsy, percutaneous nephrolithotripsy and ureteroscopy, the need for open surgery has decreased, even in this anatomically unique and surgically challenging patient population.

Summary: Urolithiasis is an established long-term complication of urinary diversion. In recent years, significant advances have been made in the pathogenesis, diagnosis and treatment of such stones. As a result of potential stone-related complications, we recommend lifelong surveillance for all patients with urinary stones and diversions, with medical therapy when indicated, in order to minimize these complications.