Development of a large bladder calculus on sutures used for pubic bone closure following extrophy repair

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.