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Management and aetiology of stones in intestinal urinary reservoirs in adolescents
1Institute of Urology, 48 Riding House Street, London W1P 7PN, UK. cwoodhouse@compuserve.com
Insights
Reservoir stones in patients with intestinal urinary reservoirs are typically struvite and linked to poor drainage. Percutaneous removal is effective for stones up to 5 cm.
Area of Science:
- Urology
- Nephrology
- Surgical Innovation
Background:
- Intestinal urinary reservoirs are surgically created bladders used in reconstructive urology.
- Reservoir stones (calculi) pose a significant complication, impacting patient health and quality of life.
- Understanding the etiology and optimizing management of these stones is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the causes (aetiology) and treatment strategies for reservoir stones in patients with intestinal urinary reservoirs.
- To analyze the incidence and characteristics of stone formation in various types of urinary reservoirs.
- To evaluate the effectiveness of different surgical approaches for stone removal.
Main Methods:
- Prospective follow-up of patients with enterocystoplasty since 1983.
- Review of data from 148 patients who underwent reconstruction for congenital anomalies.
- Analysis of stone incidence, management, and aetiology in a cohort of 146 patients with complete follow-up data.
Main Results:
- 15.8% of patients (23/146) developed reservoir stones, with a mean time to formation of 45 months.
- All analyzed stones were composed of struvite (infectious calculi).
- Incidence varied by reservoir type: Kock pouch (50%), Mitrofanoff drainage (100%), urethral catheterization (9%), other abdominal reservoirs (7.5%). No spontaneous voiding patients formed stones.
Conclusions:
- Reservoir stones are primarily infectious in origin, with struvite being the common composition.
- The incidence of stone formation is strongly correlated with impaired, non-gravitational bladder emptying.
- Percutaneous removal is a viable option for stones up to 5 cm; open removal for larger calculi.
Objective:
To review the aetiology and management of reservoir stones in patients with intestinal urinary reservoirs.
Subjects And Methods:
Since 1983 patients with enterocystoplasty have been followed prospectively by protocol. The data sets and notes of 148 patients reconstructed for congenital anomalies were reviewed to retrieve information on the incidence, management and aetiology of reservoir stones.
Results:
Data were complete on 146 patients, 2 others having been lost to follow-up. Mean follow-up was 3.4 (range 1-14) years. Twenty-three patients formed stones (15.8%). Mean time to stone formation was 45 months (range 1 month to 10 years). In 13 patients the stones were removed by a percutaneous approach. In 9 patients with large stones (>5 cm) an open removal was performed. One patient had a small stone removed through a Kock nipple. All stones were struvite on analysis. All patients with an augmented bladder drained by a supra-pubic Mitrofanoff formed stones at some time. The incidence of stones in other groups was: Kock pouch 50%; reservoirs drained by urethral catheterisation 9%; all other abdominal reservoirs 7.5%. No patient who voided spontaneously formed stones.
Conclusion:
Reservoir stones are infective in composition. The incidence is strongly related to the lack of downward, gravitational emptying. Stones up to 5 cm can be removed percutaneously.
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