Stones in Urinary Diversions

Abstract

The formation of urinary stones is one of the most common complications of urinary diversions, both incontinent (uretero-cutaneostomy, ileal and colonic conduits) and continent (ureterosigmoidostomy, rectal bladder, orthotopic neobladder and pouches). The causes and risk factors for urinary stone formation in patients with urinary diversion are many and different for each type of diversion: urinary stasis, foreign bodies (sutures, staples and catheters) and metabolic disorders. The metabolic complications (reduced daily urine output with concentrated urine, hyperoxaluria, hypercalciuria and hypocitraturia) may be consequent to the removal of a portion of the bowel tract and / or to the contact of the intestine with the urine. The indications for the treatment of urinary calculi in patients with urinary diversion are not different from those in patients with intact urinary tract, however, the use of endourological instrumentation may be more difficult. Prophylaxis is based on the correction of the factors that cause urinary stasis, increased water intake and correction of acidosis with chronic administration of potassium citrate and / or bicarbonate and calcium supplementation in the presence of enteric hyperoxaluria.