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Percutaneous Nephrolithotripsy in Patients with Urinary Diversions: A Case-Control Comparison of Perioperative Outcomes.
MedLine Citation:
PMID:  21823981     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Abstract Purpose: To compare the operative techniques and perioperative outcomes of patients with urinary intestinal diversions undergoing percutaneous nephrolithotripsy (PCNL), to a control cohort of patients without diversions. Patients and Methods: The medical records of all patients who were treated with PCNL from 1990 to 2009 were retrospectively reviewed. Each urinary diversion patient's first PCNL was age-matched with four controls who were undergoing PCNL. The perioperative outcomes were compared between the diversion and control cohorts. Results: Twenty-five patients with a urinary diversion who had undergone 33 PCNLs were identified. The mean age was 49.3 (8-85) years for the diversion group and 48.9 (4-84) for the control group. Urinary tract infection (64% vs 15% patients, P<0.0001), neurologic disease (64% vs 2%, P<0.0001), previous procedure for the same calculus (24% vs 4%, P=0.0004), urinary tract abnormalities (56% vs 14%, P<0.0001), solitary kidney (20% vs 3%, P=0.0081), and struvite stones (80% vs 12.5%, P=0.0006) were more commonly observed in the diversion group. Percutaneous access gained by a radiologist (40% vs 0%, P<0.0001), second-look nephroscopy (36% vs 16%, P=0.0466), and an increase in the frequency of fever or sepsis (8% vs 0%, P=0.0387) were identified more frequently in the diversion group. Conclusions: Patients with upper tract calculi and urinary diversions are challenging to the endourologist because of anatomic factors that can make percutaneous access more difficult; ultrasonography-guided access can be helpful in this setting. Patients with urinary diversions can be treated as safely and effectively by PCNL as nondiverted patients.
Authors:
Alfonso Fernandez; Kirsten Foell; Linda Nott; John D Denstedt; Hassan Razvi
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-8-8
Journal Detail:
Title:  Journal of endourology / Endourological Society     Volume:  -     ISSN:  1557-900X     ISO Abbreviation:  -     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-8-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8807503     Medline TA:  J Endourol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario , London, Ontario, Canada .
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