A Rocky Road: Bladder Stones in the Augmented Exstrophy-Epispadias Complex Patient.

Area of Science:

• Urology
• Pediatric Surgery
• Reconstructive Urology

Background:

• The exstrophy-epispadias complex (EEC) often requires bladder augmentation.
• Bladder augmentation in EEC patients can lead to stone formation.
• The choice of bowel segment for augmentation may influence stone development.

Purpose of the Study:

• To determine the rate of bladder stone formation in EEC patients with augmentation cystoplasty.
• To investigate if the choice of bowel segment impacts stone formation and surgical complications.
• To assess the recurrence rate and long-term outcomes of bladder stone treatment in this population.

Main Methods:

• Retrospective review of an IRB-approved institutional database.
• Inclusion of 259 patients with EEC and augmentation cystoplasty between 2003 and 2023.
• Analysis of stone formation rates, stone composition, time to treatment, recurrence, and complications based on bowel segment used (colon vs. ileum).

Main Results:

• Bladder stones developed in 21.6% of augmented EEC patients.
• While stones were more frequent in ileal augments (29%) than colon augments (19%), this difference was not statistically significant.
• Dahllite and struvite were the most common stone components; 74% of patients experienced recurrence requiring further surgery, with a median of 2+ stone surgeries per patient.
• Complications occurred in 14% of patients, with no significant difference between augment types.

Conclusions:

• Bladder stone management in EEC patients with augmentation cystoplasty is complex and challenging.
• The high rate of stone recurrence necessitates interventions to prevent future stone formation.
• Most patients will require multiple surgical interventions throughout their lifetime.