Infection stones in patients with myelomeningocele and ileal conduit urinary tract diversion.

Infection renal calculi are serious complications of urinary tract diversion in patients with myelomeningocele. During a 12-month period, 10 renal units containing calculi were managed surgically. The kidneys were in patients with multiple previous operations and medical problems. Nine of the ten stones had a staghorn configuration, filling the renal pelvis with calyceal extensions. Nephrectomy was necessary for a nonfunctional kidney and a conventional nephrolithotomy was done in one case. Endourologic techniques were used for treatment of eight renal units. Endourologic methods depended on placement of a percutaneous nephrostomy tube. The nephrostomy tract was dilated, then renal calculi were disintegrated under direct vision using ultrasound, and the stone fragments were removed. Six of eight kidneys (75%) were rendered stone-free using these methods. The other two kidneys had residual stone fragments located in isolated calyces with little potential for obstruction. Skin breakdown occurred in two patients, and two patients required transfusions. These results compared favorably with the results of conventional open surgery. Major advantages of percutaneous nephrolithotomy were evident during the postoperative period. Since there was minimal incision discomfort, patients were easily mobilized and there were no pulmonary problems. Patients were able to resume oral intake on the day of surgery and usually resumed full activities within one week of discharge. Percutaneous methods are a valuable aspect of a total therapeutic program for infection renal calculi in patients with myelomeningocele.