LONG-TERM INCIDENCE AND RISK FOR RECURRENT STONES FOLLOWING CONTEMPORARY MANAGEMENT OF UPPER TRACT CALCULI IN PATIENTS WITH A URINARY-DIVERSION

Purpose: The long-term rate of stone recurrence following contemporary minimally invasive management of calculi was determined in patients w ith urinary diversion and to identify specific risk factors for these recurrences. Materials and Methods: We followed for a minimum of 12 mo nths 25 patients (29 renal units) with upper tract calculi associated with urinary diversion, and treated with extracorporeal shock wave lit hotripsy and/or percutaneous nephrostolithotomy. The risk of recurrent stones at 5 years was determined by a Kaplan-Meier estimate, while po tential risk factors for recurrence were analyzed using a log-rank com parison. Results: Stones recurred in 8 patients (32%) 18 to 61 months (mean 27.0) after treatment. The risk of new stone formation after 5 y ears was estimated to be 63.3% and was significantly greater in patien ts with recurrent bacteriuria after treatment. Neither stone history, type of procedure used, stone composition nor radiographic status at c ompletion of treatment significantly influenced this risk. Conclusions : Contemporary management of upper tract calculi in patients with a ur inary diversion is associated with a high recurrence rate, especially among those with recurrent bacteriuria, regardless of whether the pati ent is initially rendered stone-free. Continued close surveillance and antibiotic prophylaxis seem to be essential in this high risk patient population.