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Development of a large bladder calculus on sutures used for pubic bone closure following extrophy repair
R Rub1, R Madeb, S Morgenstern
1Hillel Yaffe Medical Center, Department of Urology, Hadera, Israel. kashish@inter.net.il
Insights
Bladder exstrophy repair using non-absorbable sutures can lead to stone formation. Close post-operative follow-up is crucial for early detection of complications like bladder stones.
Area of Science:
- Pediatric Surgery
- Urology
- Congenital Abnormalities
Background:
- Bladder exstrophy is a rare congenital anomaly affecting 1 in 30,000 live births.
- Primary closure typically involves iliac osteotomy for secure bladder closure in newborns.
- Surgical repair aims to correct the anatomical defect and restore function.
Observation:
- A 3-year-old child developed a large bladder stone and secondary hydronephrosis.
- The patient had undergone exstrophy repair at 7 months of age.
- A non-absorbable polyester suture used for pubic bone closure was identified as the stone's nidus.
Findings:
- Non-absorbable sutures in contact with urine can act as a nidus for calculus (stone) formation.
- This case highlights the lithogenic potential of synthetic surgical materials within the urinary tract.
- Secondary complications such as hydronephrosis can arise from bladder stone obstruction.
Implications:
- Reinforces the need for careful material selection in congenital anomaly repairs.
- Emphasizes the importance of long-term, vigilant post-operative monitoring in bladder exstrophy patients.
- Suggests considering absorbable suture alternatives or meticulous suture removal/burial in bladder exstrophy repair.
Abstract:
Bladder exstrophy is a rare congenital condition that occurs in 1 to 30,000 live births. Primary bladder closure is usually performed in the first days of life in conjunction with an iliac osteotomy in order to achieve a more secure bladder closure. We report a case of a large bladder stone with secondary right-sided hydronephrosis in a 3-year-old child who underwent exstrophy repair at the age of 7 months. During the exstrophy repair a no. 1 braided, polyester, non-absorbable suture was used to close the pubic bones and served as a nidus for intravesical stone formation. This case substantiates the lithogenic nature of non-absorbable sutures in contact with urine as well as the need for close post-operative follow-up in these patients.