An updated review of stone management in patients with bladder exstrophy

After complex reconstruction, bladder exstrophy requires unique considerations for long-term surveillance that may arise through the natural history of the condition. A known long-term risk in exstrophy patients is urolithiasis which is a challenge to both treat, and prevent. The authors sought to provide an updated review on the management, prevention, and available interventions in the exstrophy patient population.

A literature review was performed through PubMed database, maintained by the United States National Library of Medicine (USNLM) at the National Institutes of Health to survey the existing body knowledge. After rigorous review, those articles included were synthesized in a concise fashion.

151 articles were initially identified that covered "stones in exstrophy." After careful review, 54 were excluded leaving 97 articles included in the final analysis. These articles were then crafted to answer for key questions pertaining to workup, techniques for intervention, and mitigation measures.

Exstrophy patients are at an increased risk for urolithiasis given several factors ranging from metabolic derangements secondary to augmentation cystoplasty and relatively increased urinary stasis. Increased volume of irrigation and adjuncts in irrigation materials may be used to minimize future stone formation. Ultimately, if stone intervention is required, there are growing options available to the reconstructive urologist.