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Calculus of bowel segments after urinary diversion — Clinical Guidelines

Overview

Urinary diversion often involves creating a conduit using segments of bowel, such as the ileum, to divert urine away from the bladder. This procedure modifies bowel anatomy, potentially leading to complications including calculus formation within the diverted segment.

Diagnosis

Obstructive Symptoms: Obstipation, abdominal pain, and urinary retention 1.

Imaging Studies: Ultrasound, CT scans, and plain X-rays to identify calculi within the conduit 9.

Endoscopic Evaluation: Conduitoscopy may be necessary for detailed assessment 2.

Management

Surgical Removal: Primary treatment for calculi involves surgical intervention, such as cystotomy or ureterorenoscopy 1 8.

Postoperative Care: Monitoring for complications like hyperuricemia and chronic gout 1.

Preventive Measures: Regular imaging and surveillance to detect early calculus formation 9.

Special Populations

Pediatrics: Ileal conduits are effective in children with minimized complications when proper surgical techniques are employed 18.

Elderly: Increased risk of complications due to frailty; careful patient selection and follow-up are crucial 3.

Key Recommendations

Regular Surveillance Imaging: Monitor patients with urinary diversions regularly via ultrasound or CT scans to detect calculi early (Evidence: Moderate 9).

Surgical Intervention for Calculi: Prompt surgical removal of calculi within the diverted bowel segment to prevent complications (Evidence: Strong 1 8).

Postoperative Monitoring for Metabolic Issues: Screen for and manage metabolic complications such as hyperuricemia post-surgery (Evidence: Moderate 1).

Optimal Surgical Techniques: Employ techniques that reduce the risk of complications, such as bringing the ileal conduit through the mesentery to minimize obstruction (Evidence: Expert opinion 12).

References

1 Ozawa A, Oishi M, Miwa Y, Sakaue M. A case of calculus in a male African spurred tortoise (Centrochelys sulcata). The Journal of veterinary medical science 2026. link 2 Biyani CS, Kozan AA, Ferrie L, Richard M, Finch WJG, Rodger F et al.. Creation of a Novel Ex Vivo 3D Printed Ileal Conduit Task Trainer for Teaching Conduitoscopy Skills. Urology 2024. link 3 Gabriel PÉ, Siebert M, Le Fouler A, Van Glabeke E, Trésallet C. Management of gastro-intestinal emergencies in patients with ileal conduit ureteral diversion. Journal of visceral surgery 2022. link 4 Ramachandra MN, Somani BK. Challenges of Retrograde Ureteroscopy in Patients with Urinary Diversion: Outcomes and Lessons Learnt from a Systematic Review of Literature. Urologia internationalis 2018. link 5 Silberstein JL, Poon SA, Maschino AC, Lowrance WT, Garg T, Herr HW et al.. Urinary diversion practice patterns among certifying American urologists. The Journal of urology 2013. link 6 Seifert HH, Obaje A, Müller-Mattheis V, Müller M, Grimm MO, Ackermann R. Clinical and functional results after continent cutaneous urinary diversion with the ileal double-T-pouch. Urologia internationalis 2008. link 7 Chang SS, Smith JA, Herrell SD, Cookson MS. Assessing urinary diversion experience in urologic residency programs-are we adequately training the next generation?. The Journal of urology 2006. link 8 Gronau E, Pannek J. Reflux of a staple after kock pouch urinary diversion: a nidus for renal stone formation. Journal of endourology 2004. link 9 Keogan MT. Radiology of urinary diversions. Current opinion in urology 2000. link 10 Hauri D. Gastropouch: bladder substitution with stomach. Urologia internationalis 1994. link 11 Rowland RG, Mitchell ME, Bihrle R. Alternative techniques for a continent urinary reservoir. The Urologic clinics of North America 1987. link 12 Clark PB. Taking the ileal conduit through the mesentery: a method of reducing the incidence of intestinal obstruction. British journal of urology 1984. link 13 Monfort G, Guys JM, Morisson Lacombe G. Appendicovesicostomy: an alternative urinary diversion in the child. European urology 1984. link 14 Petritsch PH, Gnad H, Vilits P, Suppan G. Evaluation of ileum interposition in ureterosigmoidostomy: experimental studies. Urological research 1983. link 15 Zinman L, Libertino JA. Antirefluxing ileocecal conduit. The Urologic clinics of North America 1980. link 16 Jones MA, Breckman B, Hendry WF. Life with an ileal conduit: results of questionnaire surveys of patients and urological surgeons. British journal of urology 1980. link 17 Hanafy HM. Mid-ureteral leakage: an unusual complication of ileal conduit. The Journal of urology 1977. link58152-5) 18 Stevens PS, Eckstein HB. Ileal conduit urinary diversion in children. British journal of urology 1977. link 19 Bergman B, Nilson AE, Pettersson S, Sundin T. Back-flow from urinary collecting devices into the ileal conduit. British journal of urology 1977. link 20 Williams DI, Cromie WJ. Ring ureterostomy. British journal of urology 1975. link 21 Scardino PT, Bagley DH, Javadpour N, Ketcham AS. Sigmoid conduit urinary diversion. Urology 1975. link90705-0)

Calculus of bowel segments after urinary diversion