[SS-024]

Holmium laser lithotripsy in patient with ileal conduit diversion

¹Department of Urology, Eskişehir Military Hospital, Eskisehir, Turkey
²Department of Urology, Gülhane Military Medical Academy, Ankara, Turkey
³Department of Urology, Gümüşsuyu Military Hospital, Istanbul, Turkey
⁴Department of Urology, Gülhane Military Medical Academy Haydarpasa Training Hospital, Istanbul, Turkey

AIM: Urolithiasis risk is increases after radical cystectomy postoperative due to anatomical and metabolic changes. The reported incidence of stones associated with urinary diversion ranges from 9% to 11% after ileal conduit diversion. Open surgical treatment has limited role because of high recurrence rate, postoperative tissue adhesions and anatomical changes. This makes minimally invasive endourological techniques popular. However, these techniques have not been well tested in patients with urolithiasis after urinary diversion. Here we reported holmium: YAG laser lithotripsy for stomal stone in patient with ileal conduit diversion.
Patient & METHODS: A 70-year-old man undergone cystectomy with an ileal conduit diversion because of invasive bladder cancer was admitted to our hospital for a follow-up visit. Computed tomography peformed and a 22 mm diameter urinary stone was detected in ileal conduit. This was confirmed by endoscopy with a rigit cystoscope. Holmium: YAG laser lithotripsy was performed under general anesthesia and all stone fragments removed (Figure 1). Stone-free status obtained in the patient.
RESULTS: Total operating time was approximatelly 20 minutes. The patient tolerated the procedure well. No intraoperative or postoperative complications were occurred. He was discharged from the hospital at the next day after the surgery. The convalescence was uneventful. Biochemical analysis of the stone revealed magnesium ammonium phosphate (struvite).
CONCLUSIONS: Urinary stone formation is a frequent complication of urinary diversions with high recurrence rates. Endoscopic treatment modalities combined with Holmium: YAG laser lithotripsy with its high success rates and low morbidity can be use for treatment of urinary diversion stones as an effective, safe, and minimally invasive approach.

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Figure 1

Holmium: YAG laser lithotripsy

Figure 2

Stone fragments