Urinary tract stone surgery in patients with urinary diversion and vesicostomy: a single center experience

Objective: To report our experience in percutaneous nephrolithotomy and endoscopic urinary tract stone surgery in patients with urinary diversion and vesicostomy. Materials and Methods: Data of 21 patients with urinary diversion or vesicostomy who underwent surgery for urinary tract stones in our clinic between January 2008 and January 2020 were retrospectively analyzed. Eight patients (38%) underwent percutaneous nephrolithotomy, 2 patients (9.5%) underwent antegrade flexible ureteroscopy, 4 patients (19.0%) underwent retrograde semi-rigid or flexible ureteroscopy, 5 patients (23.8%) underwent retrograde pouch lithotripsy and 2 patients (9.5%) underwent percutaneous cystolithotripsy with vesicostomy tract entrance.Preoperative and postoperative data of the patients were evaluated. Results: The male to female ratio was 16/5. The mean age of the patients was 54.6 ± 10.1 years and mean preoperative stone diameter was 2.8 ± 4.5 cm. It was determined that 14 patients (66.6%) had ileal conduit (Bricker anastomosis), 5 patients (23.8%) had ureterocutaneostomy, and 2 patients (9.5%) had vesicostomy. Stone-free rate was 85.7% after single session of treatment. In the postoperative period, febrile urinary tract infection was observed in 4 (19.0%) patients, urinary system obstruction secondary to stone in 3 (14.2%) patients and anastomotic leakage in 1 (4.7%) patient. Conclusion: Percutaneous nephrolithotomy, antegrade ureterorenoscopy, retrograde ureterorenoscopy and vesicostomy entry cystolithotripsy are highly effective and safe methods in patients with urinary diversion and vesicostomy. The most important factors affecting the success are the experience of surgical team that can apply procedural options together with careful preoperative preparation and correct instrumentation.