Management of nephrolithiasis in patients with urinary diversions pose a unique therapeutic challenge for the following reasons: 1) retrograde ureteral access is difficult to perform through a bowel diversion and 2) percutaneous renal access becomes challenging because of inability to do a retrograde pyelogram. For this reason, image-guided access through a combined ultrasound and fluoroscopic guidance are both necessary. This clinical problem becomes even more complicated when dealing with a solitary functioning kidney. Treatment should be precise in order to avoid any complications that may progress to renal failure. Presented here is a 15-year-old male adolescent who had previously undergone a radical cystectomy with an ileal conduit for a rhabdomyosarcoma of the bladder last 2008, and complained of flank pain, fever and foul-smelling urine. Imaging studies showed left obstructive hydronephrosis with ureterolithiasis and nephrolithiasis, and an atrophic contralateral kidney. A preliminary nephrostomy tube drainage was done to recover renal function, followed later by percutaneous endoscopic stone management. Discussed here are the challenges involved in his therapy as well as the advantages of a stepwise approach including the short-term outcomes.
ileal conduit ; pediatric ; solitary kidney

Ultrasonography is a useful diagnostic modality in evaluating the non-visualized kidney on IVP because visualization by this technique depends only on the morphologic and acoustic characteristics of the kidney and is independent of renal function. This non-invasive technique can accurately guide percutaneous puncture of the collecting system, permitting antegrade localization of the obstructing lesion, and percutaneous nephrostomy under the ultrasonic guidance can be performed as a means for rapid, usually temporary, urinary diversion in patients with obstructive uropathy. Many causes of IVP non-visualization have a typical sonographic appearance. 35 patients with non-visualized kidney were examined ultrasonically and 13 AGP were carried out.
Acoustics ; Humans ; Kidney ; Nephrostomy, Percutaneous ; Punctures ; Ultrasonics* ; Ultrasonography ; Urinary Diversion

Clinical observation was performed on 38 patients of the urinary diversion during 5 years and 7 months. 1) The age were distributed from 11 months to 79 years and the most of the cases (42%) were found over fifth decades. 2) Among the 38 cases, 27 were male and 11 were female with the ratio of 2.5:1. 3) The majority of etiologic disease was bladder tumor and renal tuberculosis(84%). The other causes were neurogenic bladder, ureteral obstruction due to cervical carcinoma, chronic prostatitis, ureteral tumor and bladder exstrophy (16%). 4) The methods of urinary diversion were as follows; Cutaneous ureterostomy in 26 cases, ileal conduit 7. nephrostomy 6 and cystostomy 3. 5) Complication was followed as uremia, paralytic ileus, parastomal dermatitis, pneumonia, acute pyelonephritis, sepsis, conduit bleeding, incisional hernia and wound disruption in 10 cases.
Bladder Exstrophy ; Cystostomy ; Dermatitis ; Female ; Hemorrhage ; Hernia ; Humans ; Intestinal Pseudo-Obstruction ; Male ; Pneumonia ; Prostatitis ; Pyelonephritis ; Sepsis ; Uremia ; Ureter ; Ureteral Obstruction ; Ureterostomy ; Urinary Bladder Neoplasms ; Urinary Bladder, Neurogenic ; Urinary Diversion* ; Wounds and Injuries

Percutaneous nephrostomy and indwelling ureteral stents are basic. endourologic procedures. We used .35 percutaneous nephrostomy catheters in 23 patients and success in 33 cases (94%). There were 4 complications; Obstruction due to blond clot in 3 and accidental removal in 1. In cases of internal ureteral stenting, we used 122 stents in 102 patients and success in 105 cases (86%). In operative cases, success rate was 100%, but 70% in retrograde ureteral stenting and 25% in antegrade ureteral stenting. Upward and downward migration, encrusted obstruction, severe pyelonephritis and persistent gross hematuria were occurred as complications. Although there were some complications marked improvement of uremic condition was noticed in majorities of patients. In these results, we have found the percutaneous nephrostomy. and .internal ureteral stentings were reliable in patients with ureteral obstruction, as adjuncts to genitourinary. surgery in selected instances and as external or internal diversion for patients with obstructive uropathy.
Catheters ; Hematuria ; Humans ; Nephrostomy, Percutaneous ; Pyelonephritis ; Stents ; Ureter ; Ureteral Obstruction ; Urinary Diversion*

Double J stents have been advocated for drainage or splintage of the ureter. Fifty-four attempts at double J stent insertion were made in 46 patients. In 93% attempts the stent was satisfactorily placed. Their use in adjunct to urologic and gynecologic surgery, percutaneous nephrolithotomy and ureterorenoscopy has been encouraging but poor results have been obtained in patients with ureteral obstruction due to tuberculosis and malignancy.
Drainage ; Female ; Gynecologic Surgical Procedures ; Humans ; Nephrostomy, Percutaneous ; Stents* ; Tuberculosis ; Ureter ; Ureteral Obstruction ; Urinary Diversion*

Cutaneous vesicostomy has been suggested as a useful procedure of temporary urinary diversion that can be performed and reversed easily with low incidence of complication We evaluated postoperative courses in 15 patients who underwent vesicostomy for either lower urinary tract dysfunction or obstruction. The age of the patients at the time of vesicostomy ranged from 8 days to 5.8 years(mean 18 months). The indications for vesicostomy were posterior urethral valves(5), neurogenic bladder(5), urethral stricture(31, vesicoureteral reflux(1) and anterior urethral valves(1). Associated anomalies were congenital heart disease(5), imperforated anus(3), subarachnoidal hemorrhage(1) and multicystic kidney(2). Of the 11 patients with dilated upper tracts preoperatively 10 patients improved significantly after vesicostomy while 1 remained stable. Stomal narrowing and mucosal prolapse as complications occurred in 2 patients, but none of these required surgical correction. The vesicostomy was closed successfully in 8 patients at 12 to 53 months after diversion as a simple procedure. Our experience reveals that vesicostomy is thought to be an effective, simple and easily reversible means of temporary urinary diversion to treat selected conditions in infants and children.
Child* ; Cystostomy* ; Heart ; Humans ; Incidence ; Infant* ; Prolapse ; Urinary Diversion ; Urinary Tract

Percutaneous nephrostomy was done on 101 cases with advanced malignancy and benign conditions in the Department of Urology, Kosin Medical College during the period of March, 1985 to August 1988. We were successful in using percutaneous nephrostomy as urinary diversion to ureteral obstruction or urinary leakage in 96 cases(95.1%). In four fives of patients obstruction was due to neoplasm, with the cervical cancer the leading cause. The post-nephrostomy complications were renocolon fistula in 1 case, perinephric abecess in 2 cases, severe bleeding in 3 cases. percutaneous nephrotomy proved to be ideally suited in azotemic patients and urine leakage. Its use can obviate surgical nephrostomy and prolonged ureteral catheter drainage. We also are encouraged by our early experience with extensions of percutaneous nephrostomy, including percutaneous ureteral, renal stone dissolution.
Drainage ; Fistula ; Hemorrhage ; Humans ; Nephrostomy, Percutaneous* ; Ureter ; Ureteral Obstruction ; Urinary Catheters ; Urinary Diversion ; Urology ; Uterine Cervical Neoplasms

Percutaneous nephrostomy was done on 101 cases with advanced malignancy and benign conditions in the Department of Urology, Kosin Medical College during the period of March, 1985 to August 1988. We were successful in using percutaneous nephrostomy as urinary diversion to ureteral obstruction or urinary leakage in 96 cases(95.1%). In four fives of patients obstruction was due to neoplasm, with the cervical cancer the leading cause. The post-nephrostomy complications were renocolon fistula in 1 case, perinephric abecess in 2 cases, severe bleeding in 3 cases. percutaneous nephrotomy proved to be ideally suited in azotemic patients and urine leakage. Its use can obviate surgical nephrostomy and prolonged ureteral catheter drainage. We also are encouraged by our early experience with extensions of percutaneous nephrostomy, including percutaneous ureteral, renal stone dissolution.
Drainage ; Fistula ; Hemorrhage ; Humans ; Nephrostomy, Percutaneous* ; Ureter ; Ureteral Obstruction ; Urinary Catheters ; Urinary Diversion ; Urology ; Uterine Cervical Neoplasms

Today, percutaneous nephrostomy and other related renal procedures are routine in most hospitals. This technique provides safe, rapid and direct access to the upper urinary tract for various diagnostic and therapeutic maneuvers. It has become a vital tool for the urologists who have been able to diagnose and treat ever more diverse pathologies of the urinary tract without open operation. Percutaneous nephrostomy was done on 276 cases with advanced malignancy and benign conditions during the period of March, 1985 to December, 1993. We were successful in using percutaneous nephrostomy as urinary diversion to ureteral obstruction or urinary leakage in 27l cases( 98% ). In four fifths of patients, obstruction was due to neoplasm, with the cervical cancer the leading cause. The post-nephrostomy complications were bleeding in 10 cases, enterocutaneous fistula in 4, perinephric abscess in 3 and sepsis in 1. Percutaneous nephrostomy proved to be ideally suited in condition of obstructive uropathy and urine leakage.
Abscess ; Hemorrhage ; Humans ; Intestinal Fistula ; Nephrostomy, Percutaneous* ; Pathology ; Pregnenolone Carbonitrile ; Sepsis ; Ureteral Obstruction ; Urinary Diversion ; Urinary Tract ; Uterine Cervical Neoplasms

Suprapubic cystostomy by trocar is a simple, safe and useful method for urinary diversion in acute urinary retention. But rarely, severe complications occur during or after suprapubic cystostomy such as bowel perforation, through and through perforation of the bladder, rectal injury and severe hematuria. We studied the complications of suprapubic cystostomy retrospectively and compared 19 patients who performed ultrasonographic examination with 30 patients without ultrasonographic examination. The complications in 30 patients without preliminary ultrasonographic examination were initial failure in 4 cases (13.3%), extravesical Foley indwelling in 2 cases (6.7%), puncture site closed to the pubic bone in 2 cases (6.7%), spontaneous bladder rupture in 1 case (3.3%) and bowel injury in 1 case (3.3%). But, the complication in 19 patients with preliminary ultrasonographic examination was only 1 retried case (5.3%) because of extravesical Foley indwelling. As above results, the brief preliminary ultrasonographic examination of the bladder is a very useful method with minimal risk during suprapubic cystostomy by trocar.
Cystostomy* ; Hematuria ; Humans ; Pubic Bone ; Punctures ; Retrospective Studies ; Rupture ; Surgical Instruments* ; Ultrasonography ; Urinary Bladder ; Urinary Diversion ; Urinary Retention