A Giant Ileal Conduit Calculus after Radical Cystectomy

Radical cystectomy with ileal conduit is one of the treatment options for patients with muscle invasive carcinoma bladder. Giant ileal conduit calculus is a very rare complication. A 60-year-old male had undergone radical cystectomy with ileal conduit about 12 years back and now presented left gross hydrourereteronephrosis with perinephric collection and features of renal failure. We performed drainage of perinephric collection followed by left sided percutaneous nephrostomy and patient′s condition improved gradually. Later on, we performed contrast-enhanced computed tomography (CT) intravenous urogram and nephrostogram which revealed a huge calculus of size 9 cm × 5 cm in the ileal conduit. Calculus was removed by open surgery by incising the conduit over antimesenteric border. Above presentation is a sequel of a huge ileal conduit calculus obstructing left ureter. Calculus formation can result from stomal stenosis, metabolic acidosis, small bowel syndrome, recurrent infection, any foreign body like a staple or nonabsorbing suture material. These patients require close surveillance with X-ray kidney, ureter, and bladder for a longer period after the urinary diversion. In doubtful cases, helical CT may be useful. Giant ileal conduit calculus is a very uncommon presentation after radical cystectomy.