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Bladder calculi in augmentation cystoplasty in children
R B Mathoera1, D J Kok, R J Nijman
1Department of Pediatric Urology, Josephine Nefkens Institute Rotterdam, Rotterdam, The Netherlands.
Insights
Children with augmented bladders face a 16% risk of bladder stones (urolithiasis). Key prevention strategies involve managing urinary tract infections and careful monitoring for high-risk groups, particularly girls.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Reconstructive Surgery
Background:
- Augmentation cystoplasty is a common procedure for bladder dysfunction in children.
- Bladder calculi (stones) are a significant complication following augmentation cystoplasty.
- Identifying risk factors is crucial for effective stone prevention.
Purpose of the Study:
- To evaluate risk factors and preventive strategies for bladder calculi in pediatric patients with augmented bladders.
- To identify specific patient subgroups at higher risk for urolithiasis post-augmentation cystoplasty.
Main Methods:
- Retrospective review of 89 patients undergoing augmentation cystoplasty.
- Analysis of stone formation, recurrence, and associated risk factors.
- Median follow-up of 4.9 years.
Main Results:
- 16% (14/89) of patients developed bladder calculi; 4 experienced recurrence.
- Girls exhibited a higher incidence of urolithiasis.
- Identified risk factors include cloacal malformations, vaginal reconstructions, anal atresia, catheterization issues, bladder neck surgery, and symptomatic UTIs.
Conclusions:
- Patients with cloacal malformations, vaginal reconstructions, ureter reimplantation, and bladder neck surgery require vigilant follow-up for stone prevention.
- Prompt treatment of symptomatic urinary tract infections is vital, especially in high-risk subgroups.
- Girls are at increased risk for bladder calculi after augmentation cystoplasty.
Objectives:
To determine the best preventive strategies for bladder calculi in children with an augmented bladder, the risk factors and prevention strategies for urolithiasis were evaluated.
Methods:
The records of 89 patients following augmentation cystoplasty were reviewed to assess the results of augmentation cystoplasties and in particular the formation and prevention of calculi.
Results:
The median follow-up was 4.9 years after augmentation. Most patients (71) had an ileocystoplasty. Bladder calculi occurred in 14 of the 89 patients (16%) and recurred in 4 patients. Girls had a higher incidence of urolithiasis. Other risk factors were cloacal malformations, vaginal reconstructions, anal atresia, clean intermittent catheterization problems and retention, bladder neck surgery, and symptomatic urinary tract infections.
Conclusions:
Subgroups with cloacal malformations, vaginal reconstructions, ureter reimplantation, and bladder neck surgery were identified that have an increased risk for stone formation and therefore warrant special care in the follow-up after augmentation. This care should include clear emphasis on the role of treating symptomatic urinary tract infections, especially in patients with cloacal malformations and vaginal reconstructions. Girls have a higher incidence of bladder calculi than boys.