Presented by: Kelly Lehner MD
Mayo Clinic

Introduction

Urolithiasis is one of the most frequent complications of urinary diversion. Treatment can be challenging given altered anatomy and difficulty with retrograde access. Herein, we present a case of a 32 yo male with spina bifida and ileal conduit urinary diversion who presented with left > right renal stone burden and recurrent urinary tract infections.

Materials

Patient underwent left percutaneous nephrostomy tube placement and right ureteral stent placement via ileal conduit by interventional radiology. He then proceeded to the operating room for simultaneous right retrograde ureteroscopy via the conduit and left percutaneous nephrolithotomy (PCNL).

Results

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The left nephrostomy tube tract was balloon dilated to allow access with a 30Fr sheath, while a 12-14Fr ureteral access sheath was placed on the right side (Figure 1). In a simultaneous fashion, the 2.5cm left total renal stone burden was treated using the Swiss LithoClast ® Trilogy Lithotripter and the 1cm right total renal stone burden was treated via basket extraction using the flexible ureteroscope. Total operative time was 97 min. He discharged on postoperative day 1 without complication and stone free.

Conclusion

Simultaneous retrograde ureteroscopy and contralateral PCNL is a safe and effective means of treating bilateral renal stone burden in patients with ileal conduit urinary diversion.

Funding

None

Lead Authors

Bridget Findlay, MD
Mayo Clinic

Co-Authors

Jamal Alamiri, M.B., B.Ch., B.A.O.
Mayo Clinic

Tal Cohen, MD
Mayo Clinic

Carly Thompson, RN
Mayo Clinic

Kevin Wymer, MD
Mayo Clinic

Kevin Koo, MD, MPH
Mayo Clinic

Aaron Potretzke, MD
Mayo Clinic