PURPOSE: 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. PATIENTS AND 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.
PURPOSE: 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. PATIENTS AND 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: Michael Ordon; Sero Andonian; Brian Blew; Trevor Schuler; Ben Chew; Kenneth T Pace Journal: Can Urol Assoc J Date: 2015-12-14 Impact factor: 1.862
Authors: Jason Y Lee; Sero Andonian; Naeem Bhojani; Jennifer Bjazevic; Ben H Chew; Shubha De; Hazem Elmansy; Andrea G Lantz-Powers; Kenneth T Pace; Trevor D Schuler; Rajiv K Singal; Peter Wang; Michael Ordon Journal: Can Urol Assoc J Date: 2021-12 Impact factor: 1.862
Authors: Mesut Öztürk; John C McDermott; Paul F Laeseke; Stephen Y Nakada; Sean P Hedican; Sara L Best; Mark G Kleedehn Journal: Turk J Urol Date: 2019-09-01