Percutaneous nephrolithotomy in a patient with a ureterosigmoidostomy diversion
In patients with bladder cancer, ureterosigmoidostomy has been used as a form of urinary diversion, and urinary lithiasis has been reported as a complication. A patient with a large bilateral kidney stone and ureterosigmoidostomy diversion is described. In 2012, a 61-year-old man had a cystectomy due to bladder cancer. He was lost to follow-up after presenting to the emergency department in 2016 with right flank pain and fever. Computed tomography (CT) scan reveals bilateral staghorn calculus. A bilateral percutaneous nephrostomy was performed. The patient was planned for bilateral percutaneous nephrolithotomy (PCNL). He declined, therefore we proposed External Shock Wave Lithotripsy (ESWL). The right kidney stone was removed, but the left kidney stone did not alter after 7 ESWL sessions, thus PCNL was scheduled. The middle calyx was punctured under fluoroscopic guidance through the nephrostomy in Valdivia’s modified position. Two 0.035” hydrophilic guide wires were passed down the renal pelvis and ureter until it ureterosigmoidostomy union was reached. Dilation was carried out with Nephromax. An Amplatz 30 Ch was placed. The holed stone was then fragmented with Laser Holmium. PCNL tubeless was performed. He was discharged two days after surgery. PCNL tubeless was performed. The hospital stay was two days. CT control two months later: Lower pole 5 cm hematoma, the residual stone of 4 mm in the upper calyx. After resolving the renal hematoma, the residual stone will be dealt with ESWL.
Keywords: Ureterosigmoidostomy, renal stone, percutaneous nephrolithotomy