Case Report and Review Urol Int 1992:49:114-118
Section of Urology. Carl T. Hayden VA Medical Center, Phoenix. Ariz., USA
Lithiasis in the Ileal Conduit and the Continent Urinary Pouch: Two Cases and a Review
Keyw ords
Abstract
Ileal conduit stone Continent urinary pouch stone
We present 2 patients who developed stones (6 and 57 g) in the ileal conduit; the first stone was passed and the second required surgical removal; its nidus was a surgical staple. After a review of the literature which includes 25 other cases of stones in ileal conduits, as well as over 20 cases of stones in continent urinary pouches, it is concluded that the use of metallic staples in the construc tion of the ileal conduit or the continent urinary pouch should be abandoned.
Case Reports
Review of the Literature
Case 1
A 61 -year-old male underwent a cystectomy with ileal conduit for cancer of the bladder; six years later he passed a stone from his ileos tomy; it weighed 6 g and measured 3 X 1.7 X 1.7 cm and was com posed of struvite with traces of apatite. Case 2
A 64-year-old white male underwent a radical cystectomy for car cinoma of the bladder. Two years later he first noted lancinating pains involving the region of the left kidney, and these pains remained unexplained for about 4 years. Several urograms were per formed during this period (fig. 1-3); they revealed left hydronephro sis (fig. 2) but the now obvious stone in the IC was missed. He subse quently became anuric and upon hospitalization was found to have complete obstruction of his ileal loop by a giant calculus which could not be extracted and had to be surgically removed. It weighed 57 g, measured 6.5 X 3.5 cm (fig. 4) and was composed of struvite with a trace of apatite. The stone was roentgenographed and found to con tain a metal staple (fig. 5) and CT scanning of the stone showed its intricate architectural structure (fig. 6).
Received: July 12, 1991 Accepted: December 4. 1991
A review of the literature reveals 25 similar cases [116, present report], making a total of 27 patients ( < 57%) with stones in IC, and over 20 cases with stones in CUP [14. 17-21]; half of the cases of stones in IC were fully documented and only a quarter of the cases of stones in CUP. The incidence of IC stones was almost 13 times lower than the incidence of stones in CUP. In 77.77% (21/27) of the IC patients, the stone was associated with a foreign body [2, 4-8, 11-13, 15 and our 2nd case]. Of these 21 patients, the foreign body was a staple in 18 patients (86%) [5-8. 11-13, 15 and our 2nd case], silk in 2 patients [2,4a and b] and a piece of wood in 1 patient [4a and b]. The majority of stones (90%) that formed in CUP had as nidus a metallic staple. The stones were asymptomatic in 62% (13/21) of the patients [6-8, 11. 15, 16 and our 1st case]. Hematuria was recorded in 24% (5/21 [2, 5, 10. 16]), pain in 3/21 patients [10, 18 and our 2nd case], chills and/or fever in 3/21 patients [2, 16, 18] and irritation of the stoma in 1/21 patients [3]. In 46% (16/35) of the patients the stones were small enough to pass spontaneously from the ileal stoma; they were all less than 3 cm [5-8, 11, 13, 15 and our 1st case].
Dr. Farid S. Haddad 4332 F Piccadilly Road Phoenix. AZ 85018 (USA)
© 1992 S. Karger AG. Basel 0042-1138/92/0492-0114 $2.75/0
Downloaded by: Nagoya University 133.6.82.173 - 1/14/2019 10:42:06 PM
Farid Sam i Haddad Oliver P. Campbell
Fig. 2. Intravenous urogram taken on the same day as figure 1 shows a left hydronephrosis and an opacified IC; the stone in the IC was missed (case 2).
Endoscopic stone extraction was attempted in 12 patients [3, 10. 12a and b. 14, 17, 21 and our 2nd case]; it was successful in 10 patients: 5 in IC and 5 in CUP [10, 12, 14, 17, 21]; the size of the stones was 1-2 cm. Surgical stone removal was performed in 5 patients [2, 3, 9, 21 and our 2nd case]: 4 with IC and I with CUP; the stone size was 6-9.5 cm. In 3 patients with CUP the stones were crushed with electrohydraulic lithotripsy [20] and in 1 patient with CUP, the stone was crushed by extracorporeal shock wave lithotripsy [18]. The weight of the stones was recorded 4 times only; it varied between 6 and 350 g. Stone analysis was reported 12 times: in 8 patients the stones were composed of magnesium ammonium phos phate (struvite) [ 1, 5, 20 and our 2 cases], in 3 patients the stones were a mixture of struvite and apatite [6-8], and in 1 patient the stone was found to be composed of organic
phosphates with a nidus of uric acid [9]! The stones were multiple (2-5) in 41 % (10/24) of the patients [2, 5-7, 15. 16, 18, 20], and recurred in 12% (3/24) of the patients [5, 6, 8], The interval between the construction of the IC and the diagnosis of IC stone was recorded in 18 patients [2, 3, 5, 6, 8-10, 13, 15, 16 and our 2 cases], and it varied between 3 and 72 months; the average interval was 31 months. In patients with staples in their stones, the inter val was recorded for 12 of them [5, 8, 11-15], and it var ied between 3 and 72 months and the average was 22.5 months, whereas in the 6 patients without staples in their stones [3, 9, 10, 16 and our 1st case] the interval varied between 26 and 72 months and its average was 48 months. The presence of the staple seemed to hasten the formation of the stones in the IC.
115
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Fig. 1. Simple roentgenogram of the abdomen taken 5 years after cystectomy; the shadow of the stone (arrows) in the IC was inter preted as the shadow of the stoma (case 2).
4
3
Fig. 3. Simple roentgenogram of the abdomen taken 11 months after the one shown in figures I and 2; the stone in the IC was inter preted as the shadow of the stoma (case 2). Fig. 4. The stone after surgical removal from the IC is ovoid in shape and measures 6.5 X 3.5 cm (case 2). Fig. 5. The postoperative roentgenogram of the stone removed from the IC shows a metal staple in its center (case 2). Fig. 6. A CT scan of the stone removed from the IC reveals a density of 805-914 (case 2). It is predicted that CT scanning could, in the future, be used to determine the chemical composition of stones in vivo, before their surgical removal.
The least appreciated complication of urinary diver sion is stone formation in the lumen of the IC or the CUP. At first (1967), this complication was vaguely mentioned and was only reported during discussions of other more
116
Haddad/Campbell
frequent complications: ‘stones can be found in the kid neys, ureter, bladder or even the segment itself [1], Later on, detailed case reports of stone formation in the lumen of the IC began to be published. To our knowledge, the first such report describes the formation of a stone over a black silk suture in the IC [2], Stones have already been
Lithiasis in Urinary Diversion Segments
Downloaded by: Nagoya University 133.6.82.173 - 1/14/2019 10:42:06 PM
Discussion
6
reported in IC and CUP from several countries in Europe [17, 19. 20], Australia [13], Taiwan [20] and the USA [112a and b. 22-25]. With the increased use of metallic stapling devices for the construction of IC after 1972 [13] and the construc tion of CUP. the incidence of stones in the IC seemed to increase to more than 4% of patients [15], and it is presently about 7.6% in patients in whom a CUP had been constructed. Most probably this etiological nidus is being missed in some cases because the staple is embed ded within the stone and its presence is not readily sus pected. We recommend that all IC and CUP stones, whether passed spontaneously or removed endoscopically or surgically, be radiographed. In order to avoid the serious complications that may result from stones in IC and in CUP, a concerted effort should be made to diagnose them as early as possible. This can only be achieved if the slightest symptoms such as hematuria or pain are taken seriously and if endoscopy is routinely performed every 3 months especially if metal lic staples had been used. Reliance on roentgenological diagnosis can be treacherous because of the confusion that may arise from the bony structures of the pelvis. In the loopogram, a stone can be seen as a filling defect [ 16], but ultrasound, especially in CUP, has been shown to give a diagnosis in almost 100% of the cases, compared to 75 % accuracy in roentgenography [19], Usually stones in the IC manifest their presence about 2.5 years after the construction of the IC. Most are asymp tomatic but, in a few, hematuria and pain are symptoms to be taken seriously. Fortunately, 46% of the stones that form in the IC and CUP are small and pass spontaneously but 54% grow to a large size and require endoscopic extraction (one stone was extracted with a gastroscope
[10]), electrohydraulic lithotripsy, extracorporeal shock wave lithotripsy or open surgery. Large stones (the largest reported was 350 g) may have serious consequences such as perforation of the IC [2] or anuria [our 2nd case]. These complications are not as simple as some want us to believe [15]. Two suggestions are offered to decrease the likelihood of the formation of stones on a metallic staple nidus. (l)T he use of absorbable staples (developed in 1982) instead of the metallic ones [12a and b, 15]. Mere exclu sion of the staple line from the urinary stream using an inverting stitch distal to the staple line has proven disap pointing [ 13], Absorbable staples have been successfully used both in the dog to create diversionary urinary reser voirs [28] and in the human [ 12a and b], (2) The resection of the proximal stapled end of the IC and its manual clo sure with absorbable material [25],
Conclusion
The number of stones in IC and CUP that have been reported in the literature does not reveal their true inci dence. Furthermore, the complications of IC stones can be very serious and the morbidity significant. These are the reasons that convinced us to suggest that the use of metallic staples for the construction of IC or CUP be finally and definitely abandoned.
Acknowledgements Thanks are due to Lynda Stone, Karen Turis and Norman Brown for the figures and to Marc Simmons for the references.
References 4bDret!er SP: The pathogenesis of urinary' tract calculi occurring after ileal conduit diversion. I. Clinical study. II. Conduit study. III. Pre vention. J Urol 1973;109:204-209. 5 Assadina S. Lee ChN. Petrc JH, Lyons RC: Two cases of stone formation in ileal conduits after using staple gun for closure of proximal end of isolated loop. J Urol 1972:100:553. 6 Bisson J, Vinson RK. Leadbetter GW: Urolith iasis from stapler anastomosis. Am J Surg 1979;137:280-282. 7 Bergman SM; Sears HF. Javadpour N: Compli cation with mechanical stapling device in crea tion of ileoconduit. Urology 1978:12:71-73.
8 Heney NM. Dretler SP. Hensle TW. Kerr WS: Autosuturing device in intestinal urinary con duits. Urology 1978:12:650-653. 9 Hoeksma J, Zamora S, McKiel Ch, Guinan P: A case profile: Giant ileal conduit stone. Urol ogy 1979;14:192-193. 10 Khera DC, Sosa F: Removal of a calculus from an ileal conduit with a fiberoptic gastroscope. Gastrointest Endosc 1980;26:156-157. 11 Meyers RP, Rife CC. Barrett DM: Experience with the bowel stapler for ileal conduit urinary diversion. Br J Urol 1982;54:491-493. 12a Wheeless CR Jr: Stapling techniques in opera tions for malignant disease of the female geni tal tract. Surg Clin North Am 1984:64:591 — 608.
1 17
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1 Koehler PR. Bowles WT. McAlister WH: Roentgcnographic evaluation of late results of ileal loop urinary diversion in infants and chil dren. Am J Roentgenol 1967;100:177-185. 2 Halverstadt DB. Fraley EE: Perforation of ileal segment by calculi formed on non-absorbable suture material: Unusual complication of ileal conduit diversion. J Urol 1969;102:188-190. 3 Navani Sh. Diznoff B. Collins W. Marchant D: A giant calculus in an ileal conduit. J Urol 1970;104:269-270. 4aDrctler SP: Urinary tract calculi and ileal con duit diversion. Am J Surg 1972;123:480-483.
12bWheeless CR Jr: Use of absorbable staples for closure of proximal end of ileal loops. J Obstet Gynecol 1986;67:280-283. 13 Costello AJ, Johnson DE: Modified auto-su ture technique for ileal conduit construction in urinary diversion. Aust NZ J Surg I984;54: 477-482. 14 Skinner DG, Boyd SD, Licskovsky G: Clinical experience with the Kock continent ileal reser voir for urinary diversion. J Urol 1984; 132: 1101-1107. 15 Brenner M, Johnson DE: Ileal conduit calculi from stapler anastomosis: A long-term compli cation? Urology 1985;26:537-540. 16 Amis ES Jr, Cronan JJ, Pfister RC: Filling defects in small bowel urinary conduits. Am J Roentgenol 1981;137:787-792. 17 Hoitsma HF, Meijer S, Post E: Continent uros tomy: A clinical experience in 20 patients. Eur Urol 1987:13:368-371. 18 Boyd SD, Everett RW, Schiff WM. Fugelso PD: Treatment of unusual Kock pouch urinary calculi with extracorporeal shock wave litho tripsy. J Urol 1988; 139:805-806.
19 Kruyt RH. Kums JJ: Kock pouch urinary di version: Follow-up by ultrasound. Br J Radiol 1988;61:811-816. 20 Chen KK, Chang LS. Chen MT, Lee YH: Eleetrohydraulic lithotripsy for stones in Kock pouch. Eur Urol 1989:16:110-113. 21 Leonard MP; Gearhart JP, Jeffs RD: Conti nent urinary reservoirs in pediatric urological practice. J Urol 1990:144:330-333. 22 Hampel N, Kursh ED. Persky L: Staghorn cal culus due to migration of foreign body: Un usual complication of ileal conduit. Urology 1978;12:67-68. 23 Miedema EB, Redman JF: Case profile: Radiolucent urethral calculus with hemostatic clip nidus. Urology 1982; 19:328. 24 Landrigan RR, Finney RP. Hopkins SC: Post operative complication from hemostatic clips. Urology 1987:30:373-374. 25 Webster GD. Henry HH, Tomlin EM: Calculus formation and ureteral obstruction after ileal conduit construction using autosuture stapling device. Urology 1987;30:571-573.
26 Haddad FS: Albucassis. Abbottempo 1968:3: 22-25. 27 Gudger EW: Stitching wounds with the mandi bles of ants and beetles. JAMA 1925:84:18611864 28 Spink MS, Lewis GL; Albucasis: On surgery and instruments. Berkeley, University of Cali fornia 1973, p 550. 29 Hardy KJ: Non-suture anastomosis: The his torical development. Aust NZ J Surg 1990:60: 625-533. 30 Haddad FS: News of medical meetings and congresses. Ann Rep Orient Hosp 1954;7:53— 65. 31 Nakayama K: Simplication of the Billroth 1 gastric resection. Surgery 1954;35:837-843. 32 Ravitch MM: Development of intestinal anas tomotic devices. South Med J 1982:75:1520-
118
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Lithiasis in Urinary Diversion Segments
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33 Bonney WW. Robinson RA: Absorbable sta ples in continent ileal urinary pouch. Urology 1990;35:57-62.
Section of Urology. Carl T. Hayden VA Medical Center, Phoenix. Ariz., USA
Lithiasis in the Ileal Conduit and the Continent Urinary Pouch: Two Cases and a Review
Keyw ords
Abstract
Ileal conduit stone Continent urinary pouch stone
We present 2 patients who developed stones (6 and 57 g) in the ileal conduit; the first stone was passed and the second required surgical removal; its nidus was a surgical staple. After a review of the literature which includes 25 other cases of stones in ileal conduits, as well as over 20 cases of stones in continent urinary pouches, it is concluded that the use of metallic staples in the construc tion of the ileal conduit or the continent urinary pouch should be abandoned.
Case Reports
Review of the Literature
Case 1
A 61 -year-old male underwent a cystectomy with ileal conduit for cancer of the bladder; six years later he passed a stone from his ileos tomy; it weighed 6 g and measured 3 X 1.7 X 1.7 cm and was com posed of struvite with traces of apatite. Case 2
A 64-year-old white male underwent a radical cystectomy for car cinoma of the bladder. Two years later he first noted lancinating pains involving the region of the left kidney, and these pains remained unexplained for about 4 years. Several urograms were per formed during this period (fig. 1-3); they revealed left hydronephro sis (fig. 2) but the now obvious stone in the IC was missed. He subse quently became anuric and upon hospitalization was found to have complete obstruction of his ileal loop by a giant calculus which could not be extracted and had to be surgically removed. It weighed 57 g, measured 6.5 X 3.5 cm (fig. 4) and was composed of struvite with a trace of apatite. The stone was roentgenographed and found to con tain a metal staple (fig. 5) and CT scanning of the stone showed its intricate architectural structure (fig. 6).
Received: July 12, 1991 Accepted: December 4. 1991
A review of the literature reveals 25 similar cases [116, present report], making a total of 27 patients ( < 57%) with stones in IC, and over 20 cases with stones in CUP [14. 17-21]; half of the cases of stones in IC were fully documented and only a quarter of the cases of stones in CUP. The incidence of IC stones was almost 13 times lower than the incidence of stones in CUP. In 77.77% (21/27) of the IC patients, the stone was associated with a foreign body [2, 4-8, 11-13, 15 and our 2nd case]. Of these 21 patients, the foreign body was a staple in 18 patients (86%) [5-8. 11-13, 15 and our 2nd case], silk in 2 patients [2,4a and b] and a piece of wood in 1 patient [4a and b]. The majority of stones (90%) that formed in CUP had as nidus a metallic staple. The stones were asymptomatic in 62% (13/21) of the patients [6-8, 11. 15, 16 and our 1st case]. Hematuria was recorded in 24% (5/21 [2, 5, 10. 16]), pain in 3/21 patients [10, 18 and our 2nd case], chills and/or fever in 3/21 patients [2, 16, 18] and irritation of the stoma in 1/21 patients [3]. In 46% (16/35) of the patients the stones were small enough to pass spontaneously from the ileal stoma; they were all less than 3 cm [5-8, 11, 13, 15 and our 1st case].
Dr. Farid S. Haddad 4332 F Piccadilly Road Phoenix. AZ 85018 (USA)
© 1992 S. Karger AG. Basel 0042-1138/92/0492-0114 $2.75/0
Downloaded by: Nagoya University 133.6.82.173 - 1/14/2019 10:42:06 PM
Farid Sam i Haddad Oliver P. Campbell
Fig. 2. Intravenous urogram taken on the same day as figure 1 shows a left hydronephrosis and an opacified IC; the stone in the IC was missed (case 2).
Endoscopic stone extraction was attempted in 12 patients [3, 10. 12a and b. 14, 17, 21 and our 2nd case]; it was successful in 10 patients: 5 in IC and 5 in CUP [10, 12, 14, 17, 21]; the size of the stones was 1-2 cm. Surgical stone removal was performed in 5 patients [2, 3, 9, 21 and our 2nd case]: 4 with IC and I with CUP; the stone size was 6-9.5 cm. In 3 patients with CUP the stones were crushed with electrohydraulic lithotripsy [20] and in 1 patient with CUP, the stone was crushed by extracorporeal shock wave lithotripsy [18]. The weight of the stones was recorded 4 times only; it varied between 6 and 350 g. Stone analysis was reported 12 times: in 8 patients the stones were composed of magnesium ammonium phos phate (struvite) [ 1, 5, 20 and our 2 cases], in 3 patients the stones were a mixture of struvite and apatite [6-8], and in 1 patient the stone was found to be composed of organic
phosphates with a nidus of uric acid [9]! The stones were multiple (2-5) in 41 % (10/24) of the patients [2, 5-7, 15. 16, 18, 20], and recurred in 12% (3/24) of the patients [5, 6, 8], The interval between the construction of the IC and the diagnosis of IC stone was recorded in 18 patients [2, 3, 5, 6, 8-10, 13, 15, 16 and our 2 cases], and it varied between 3 and 72 months; the average interval was 31 months. In patients with staples in their stones, the inter val was recorded for 12 of them [5, 8, 11-15], and it var ied between 3 and 72 months and the average was 22.5 months, whereas in the 6 patients without staples in their stones [3, 9, 10, 16 and our 1st case] the interval varied between 26 and 72 months and its average was 48 months. The presence of the staple seemed to hasten the formation of the stones in the IC.
115
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Fig. 1. Simple roentgenogram of the abdomen taken 5 years after cystectomy; the shadow of the stone (arrows) in the IC was inter preted as the shadow of the stoma (case 2).
4
3
Fig. 3. Simple roentgenogram of the abdomen taken 11 months after the one shown in figures I and 2; the stone in the IC was inter preted as the shadow of the stoma (case 2). Fig. 4. The stone after surgical removal from the IC is ovoid in shape and measures 6.5 X 3.5 cm (case 2). Fig. 5. The postoperative roentgenogram of the stone removed from the IC shows a metal staple in its center (case 2). Fig. 6. A CT scan of the stone removed from the IC reveals a density of 805-914 (case 2). It is predicted that CT scanning could, in the future, be used to determine the chemical composition of stones in vivo, before their surgical removal.
The least appreciated complication of urinary diver sion is stone formation in the lumen of the IC or the CUP. At first (1967), this complication was vaguely mentioned and was only reported during discussions of other more
116
Haddad/Campbell
frequent complications: ‘stones can be found in the kid neys, ureter, bladder or even the segment itself [1], Later on, detailed case reports of stone formation in the lumen of the IC began to be published. To our knowledge, the first such report describes the formation of a stone over a black silk suture in the IC [2], Stones have already been
Lithiasis in Urinary Diversion Segments
Downloaded by: Nagoya University 133.6.82.173 - 1/14/2019 10:42:06 PM
Discussion
6
reported in IC and CUP from several countries in Europe [17, 19. 20], Australia [13], Taiwan [20] and the USA [112a and b. 22-25]. With the increased use of metallic stapling devices for the construction of IC after 1972 [13] and the construc tion of CUP. the incidence of stones in the IC seemed to increase to more than 4% of patients [15], and it is presently about 7.6% in patients in whom a CUP had been constructed. Most probably this etiological nidus is being missed in some cases because the staple is embed ded within the stone and its presence is not readily sus pected. We recommend that all IC and CUP stones, whether passed spontaneously or removed endoscopically or surgically, be radiographed. In order to avoid the serious complications that may result from stones in IC and in CUP, a concerted effort should be made to diagnose them as early as possible. This can only be achieved if the slightest symptoms such as hematuria or pain are taken seriously and if endoscopy is routinely performed every 3 months especially if metal lic staples had been used. Reliance on roentgenological diagnosis can be treacherous because of the confusion that may arise from the bony structures of the pelvis. In the loopogram, a stone can be seen as a filling defect [ 16], but ultrasound, especially in CUP, has been shown to give a diagnosis in almost 100% of the cases, compared to 75 % accuracy in roentgenography [19], Usually stones in the IC manifest their presence about 2.5 years after the construction of the IC. Most are asymp tomatic but, in a few, hematuria and pain are symptoms to be taken seriously. Fortunately, 46% of the stones that form in the IC and CUP are small and pass spontaneously but 54% grow to a large size and require endoscopic extraction (one stone was extracted with a gastroscope
[10]), electrohydraulic lithotripsy, extracorporeal shock wave lithotripsy or open surgery. Large stones (the largest reported was 350 g) may have serious consequences such as perforation of the IC [2] or anuria [our 2nd case]. These complications are not as simple as some want us to believe [15]. Two suggestions are offered to decrease the likelihood of the formation of stones on a metallic staple nidus. (l)T he use of absorbable staples (developed in 1982) instead of the metallic ones [12a and b, 15]. Mere exclu sion of the staple line from the urinary stream using an inverting stitch distal to the staple line has proven disap pointing [ 13], Absorbable staples have been successfully used both in the dog to create diversionary urinary reser voirs [28] and in the human [ 12a and b], (2) The resection of the proximal stapled end of the IC and its manual clo sure with absorbable material [25],
Conclusion
The number of stones in IC and CUP that have been reported in the literature does not reveal their true inci dence. Furthermore, the complications of IC stones can be very serious and the morbidity significant. These are the reasons that convinced us to suggest that the use of metallic staples for the construction of IC or CUP be finally and definitely abandoned.
Acknowledgements Thanks are due to Lynda Stone, Karen Turis and Norman Brown for the figures and to Marc Simmons for the references.
References 4bDret!er SP: The pathogenesis of urinary' tract calculi occurring after ileal conduit diversion. I. Clinical study. II. Conduit study. III. Pre vention. J Urol 1973;109:204-209. 5 Assadina S. Lee ChN. Petrc JH, Lyons RC: Two cases of stone formation in ileal conduits after using staple gun for closure of proximal end of isolated loop. J Urol 1972:100:553. 6 Bisson J, Vinson RK. Leadbetter GW: Urolith iasis from stapler anastomosis. Am J Surg 1979;137:280-282. 7 Bergman SM; Sears HF. Javadpour N: Compli cation with mechanical stapling device in crea tion of ileoconduit. Urology 1978:12:71-73.
8 Heney NM. Dretler SP. Hensle TW. Kerr WS: Autosuturing device in intestinal urinary con duits. Urology 1978:12:650-653. 9 Hoeksma J, Zamora S, McKiel Ch, Guinan P: A case profile: Giant ileal conduit stone. Urol ogy 1979;14:192-193. 10 Khera DC, Sosa F: Removal of a calculus from an ileal conduit with a fiberoptic gastroscope. Gastrointest Endosc 1980;26:156-157. 11 Meyers RP, Rife CC. Barrett DM: Experience with the bowel stapler for ileal conduit urinary diversion. Br J Urol 1982;54:491-493. 12a Wheeless CR Jr: Stapling techniques in opera tions for malignant disease of the female geni tal tract. Surg Clin North Am 1984:64:591 — 608.
1 17
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1 Koehler PR. Bowles WT. McAlister WH: Roentgcnographic evaluation of late results of ileal loop urinary diversion in infants and chil dren. Am J Roentgenol 1967;100:177-185. 2 Halverstadt DB. Fraley EE: Perforation of ileal segment by calculi formed on non-absorbable suture material: Unusual complication of ileal conduit diversion. J Urol 1969;102:188-190. 3 Navani Sh. Diznoff B. Collins W. Marchant D: A giant calculus in an ileal conduit. J Urol 1970;104:269-270. 4aDrctler SP: Urinary tract calculi and ileal con duit diversion. Am J Surg 1972;123:480-483.
12bWheeless CR Jr: Use of absorbable staples for closure of proximal end of ileal loops. J Obstet Gynecol 1986;67:280-283. 13 Costello AJ, Johnson DE: Modified auto-su ture technique for ileal conduit construction in urinary diversion. Aust NZ J Surg I984;54: 477-482. 14 Skinner DG, Boyd SD, Licskovsky G: Clinical experience with the Kock continent ileal reser voir for urinary diversion. J Urol 1984; 132: 1101-1107. 15 Brenner M, Johnson DE: Ileal conduit calculi from stapler anastomosis: A long-term compli cation? Urology 1985;26:537-540. 16 Amis ES Jr, Cronan JJ, Pfister RC: Filling defects in small bowel urinary conduits. Am J Roentgenol 1981;137:787-792. 17 Hoitsma HF, Meijer S, Post E: Continent uros tomy: A clinical experience in 20 patients. Eur Urol 1987:13:368-371. 18 Boyd SD, Everett RW, Schiff WM. Fugelso PD: Treatment of unusual Kock pouch urinary calculi with extracorporeal shock wave litho tripsy. J Urol 1988; 139:805-806.
19 Kruyt RH. Kums JJ: Kock pouch urinary di version: Follow-up by ultrasound. Br J Radiol 1988;61:811-816. 20 Chen KK, Chang LS. Chen MT, Lee YH: Eleetrohydraulic lithotripsy for stones in Kock pouch. Eur Urol 1989:16:110-113. 21 Leonard MP; Gearhart JP, Jeffs RD: Conti nent urinary reservoirs in pediatric urological practice. J Urol 1990:144:330-333. 22 Hampel N, Kursh ED. Persky L: Staghorn cal culus due to migration of foreign body: Un usual complication of ileal conduit. Urology 1978;12:67-68. 23 Miedema EB, Redman JF: Case profile: Radiolucent urethral calculus with hemostatic clip nidus. Urology 1982; 19:328. 24 Landrigan RR, Finney RP. Hopkins SC: Post operative complication from hemostatic clips. Urology 1987:30:373-374. 25 Webster GD. Henry HH, Tomlin EM: Calculus formation and ureteral obstruction after ileal conduit construction using autosuture stapling device. Urology 1987;30:571-573.
26 Haddad FS: Albucassis. Abbottempo 1968:3: 22-25. 27 Gudger EW: Stitching wounds with the mandi bles of ants and beetles. JAMA 1925:84:18611864 28 Spink MS, Lewis GL; Albucasis: On surgery and instruments. Berkeley, University of Cali fornia 1973, p 550. 29 Hardy KJ: Non-suture anastomosis: The his torical development. Aust NZ J Surg 1990:60: 625-533. 30 Haddad FS: News of medical meetings and congresses. Ann Rep Orient Hosp 1954;7:53— 65. 31 Nakayama K: Simplication of the Billroth 1 gastric resection. Surgery 1954;35:837-843. 32 Ravitch MM: Development of intestinal anas tomotic devices. South Med J 1982:75:1520-
118
Haddad/Campbell
Lithiasis in Urinary Diversion Segments
1530
Downloaded by: Nagoya University 133.6.82.173 - 1/14/2019 10:42:06 PM
33 Bonney WW. Robinson RA: Absorbable sta ples in continent ileal urinary pouch. Urology 1990;35:57-62.
