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Radiology Page • IBJUInt. braz j urol 50 (6) • Nov-Dec 2024 • https://doi.org/10.1590/S1677-5538.IBJU.2024.9919   copy

Tomographic aspect of a giant stone in a bricker urinary diversion

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Robotic cystectomy has become increasingly popular for the treatment of muscle invasive bladder cancer, but open cystectomy is the gold standard treatment for this disease (11 Rocco B, Assumma S, Calcagnile T, Sangalli M, Turri F, Micali S, et al. Reproducibility of a modified posterior reconstruction during robotic intracorporeal neobladder reconfiguration. Int Braz J Urol. 2022;49:136-42. doi: 10.1590/S1677-5538.IBJU.2022.0417.
https://doi.org/10.1590/S1677-5538.IBJU.... , 22 McNicholas DP, El-Taji O, Siddiqui Z, Hanchanale V. Systematic review comparing uretero-enteric stricture rates between open cystectomy with ileal conduit, robotic cystectomy with extra-corporeal ileal conduit and robotic cystectomy with intra corporeal ileal conduit formation. J Robot Surg. 2024;18:100. doi: 10.1007/s11701-024-01850-9.
https://doi.org/10.1007/s11701-024-01850... ). The ileum is used as a conduit to drain urine to the abdominal wall as a urinary stoma after radical cystectomy usually (Bricker urinary diversion) (11 Rocco B, Assumma S, Calcagnile T, Sangalli M, Turri F, Micali S, et al. Reproducibility of a modified posterior reconstruction during robotic intracorporeal neobladder reconfiguration. Int Braz J Urol. 2022;49:136-42. doi: 10.1590/S1677-5538.IBJU.2022.0417.
https://doi.org/10.1590/S1677-5538.IBJU.... , 22 McNicholas DP, El-Taji O, Siddiqui Z, Hanchanale V. Systematic review comparing uretero-enteric stricture rates between open cystectomy with ileal conduit, robotic cystectomy with extra-corporeal ileal conduit and robotic cystectomy with intra corporeal ileal conduit formation. J Robot Surg. 2024;18:100. doi: 10.1007/s11701-024-01850-9.
https://doi.org/10.1007/s11701-024-01850... ). There are some complications after the radical cystectomy with Bricker reconstruction and the urolithiasis is one of the most common (33 Gómez Pascual JA, del Rosal Samaniego JM, García Galisteo E, Bonilla Parrilla R, Ramos Titos J, Alvarado Rodríguez A, et al. Litiasis gigante en derivación urinaria tipo Bricker. Uropatía obstructiva como forma de presentación [Giant stone in a Bricker urinary diversion. Obstruction uropathy as the presenting form]. Actas Urol Esp. 2003;27:240-3. Spanish. doi: 10.1016/s0210-4806(03)72912-x.
https://doi.org/10.1016/s0210-4806(03)72... –55 Okhunov Z, Duty B, Smith AD, Okeke Z. Management of urolithiasis in patients after urinary diversions. BJU Int. 2011;108:330-6. doi: 10.1111/j.1464-410X.2011.10194.x.
https://doi.org/10.1111/j.1464-410X.2011... ). Many factors contribute to stone formation, being urinary stasis, mucus production and bacteriuria the most important (33 Gómez Pascual JA, del Rosal Samaniego JM, García Galisteo E, Bonilla Parrilla R, Ramos Titos J, Alvarado Rodríguez A, et al. Litiasis gigante en derivación urinaria tipo Bricker. Uropatía obstructiva como forma de presentación [Giant stone in a Bricker urinary diversion. Obstruction uropathy as the presenting form]. Actas Urol Esp. 2003;27:240-3. Spanish. doi: 10.1016/s0210-4806(03)72912-x.
https://doi.org/10.1016/s0210-4806(03)72... , 44 Espinheira Santos V, Costa Borges EV, de Oliveira Carneiro J, Rodrigues de Araújo JL, Araújo Andrade J. Giant Stone in Ileal Conduit. Urol Int. 2020;104:163-6. doi: 10.1159/000499091.
https://doi.org/10.1159/000499091... ). One of the techniques to treat urolithiasis in Bricker diversion is the open surgical removal, mainly in large stones (33 Gómez Pascual JA, del Rosal Samaniego JM, García Galisteo E, Bonilla Parrilla R, Ramos Titos J, Alvarado Rodríguez A, et al. Litiasis gigante en derivación urinaria tipo Bricker. Uropatía obstructiva como forma de presentación [Giant stone in a Bricker urinary diversion. Obstruction uropathy as the presenting form]. Actas Urol Esp. 2003;27:240-3. Spanish. doi: 10.1016/s0210-4806(03)72912-x.
https://doi.org/10.1016/s0210-4806(03)72... –55 Okhunov Z, Duty B, Smith AD, Okeke Z. Management of urolithiasis in patients after urinary diversions. BJU Int. 2011;108:330-6. doi: 10.1111/j.1464-410X.2011.10194.x.
https://doi.org/10.1111/j.1464-410X.2011... ). In this paper we present a 65-year-old patient with a large stone inside of Bricker, 5 years after radical cystectomy for the treatment of muscle invasive bladder cancer. The patient had pain and urinary infection with fever. The CT shows a stone inside the Bricker measuring 6.5cm (Figure-1). The patient was submitted to open laparotomy to remove the stone inside the Bricker. The stone weighted 670g (Figure-1). The patient had excellent evolution after the procedure.

Figure 1
A) The figure shows the CT with the measurement of the stone inside the urinary diversion; B) In this figure we can observe a CT reconstruction showing the aspects of the Bricker stone; C) The figure shows the access to the Bricker to remove the stone and D) The figure shows the stone with 6.6cm removed after the open surgery.

REFERENCES

  • 1
    Rocco B, Assumma S, Calcagnile T, Sangalli M, Turri F, Micali S, et al. Reproducibility of a modified posterior reconstruction during robotic intracorporeal neobladder reconfiguration. Int Braz J Urol. 2022;49:136-42. doi: 10.1590/S1677-5538.IBJU.2022.0417.
    » https://doi.org/10.1590/S1677-5538.IBJU.2022.0417
  • 2
    McNicholas DP, El-Taji O, Siddiqui Z, Hanchanale V. Systematic review comparing uretero-enteric stricture rates between open cystectomy with ileal conduit, robotic cystectomy with extra-corporeal ileal conduit and robotic cystectomy with intra corporeal ileal conduit formation. J Robot Surg. 2024;18:100. doi: 10.1007/s11701-024-01850-9.
    » https://doi.org/10.1007/s11701-024-01850-9
  • 3
    Gómez Pascual JA, del Rosal Samaniego JM, García Galisteo E, Bonilla Parrilla R, Ramos Titos J, Alvarado Rodríguez A, et al. Litiasis gigante en derivación urinaria tipo Bricker. Uropatía obstructiva como forma de presentación [Giant stone in a Bricker urinary diversion. Obstruction uropathy as the presenting form]. Actas Urol Esp. 2003;27:240-3. Spanish. doi: 10.1016/s0210-4806(03)72912-x.
    » https://doi.org/10.1016/s0210-4806(03)72912-x
  • 4
    Espinheira Santos V, Costa Borges EV, de Oliveira Carneiro J, Rodrigues de Araújo JL, Araújo Andrade J. Giant Stone in Ileal Conduit. Urol Int. 2020;104:163-6. doi: 10.1159/000499091.
    » https://doi.org/10.1159/000499091
  • 5
    Okhunov Z, Duty B, Smith AD, Okeke Z. Management of urolithiasis in patients after urinary diversions. BJU Int. 2011;108:330-6. doi: 10.1111/j.1464-410X.2011.10194.x.
    » https://doi.org/10.1111/j.1464-410X.2011.10194.x

Publication Dates

  • Publication in this collection
    07 Oct 2024
  • Date of issue
    Nov-Dec 2024

History

  • Received
    10 July 2024
  • Accepted
    30 July 2024
  • Published
    10 Aug 2024
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