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Endoscopic management of bladder calculi following augmentation cystoplasty
L S Palmer1, I Franco, E F Reda
1Section of Pediatric Urology, Albert Einstein College of Medicine, Bronx, New York.
Insights
Endoscopic treatment effectively removes bladder stones in children after augmentation cystoplasty. This approach is safe and avoids complications, with open surgery reserved for large stone burdens.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
Background:
- Bladder calculi are a complication following augmentation cystoplasty in children.
- Management of these calculi requires careful consideration of the reconstructed bladder anatomy.
Purpose of the Study:
- To evaluate the effectiveness and utility of endoscopic management for bladder calculi in children post-augmentation cystoplasty.
- To determine indications for open vesicolithotomy.
Main Methods:
- Retrospective review of 26 children with bladder calculi after augmentation cystoplasty (1981-1993).
- Analysis of management approaches (endoscopic vs. open) and outcomes.
Main Results:
- Nineteen cases managed endoscopically with complete stone extraction in a single session.
- Three cases required open vesicolithotomy; four calculi passed spontaneously.
- No infections, strictures, or complications reported with endoscopic treatment.
- Recurrent calculi were successfully managed endoscopically.
Conclusions:
- Endoscopic management of bladder calculi is safe and effective in children following augmentation cystoplasty.
- This approach is suitable even with a reconstructed bladder neck.
- Open vesicolithotomy is indicated for very large stone burdens.
Objectives:
We sought to evaluate the effectiveness and utility of an endoscopic approach to calculi that develop in the bladders of children following augmentation cystoplasty. In addition, we aimed to determine the indications for open vesicolithotomy.
Methods:
We reviewed our experience between 1981 and 1993 with 26 children who formed bladder calculi following augmentation cystoplasty. Data were retrieved retrospectively with respect to management approach and outcome.
Results:
Nineteen cases were managed cystoscopically using simple extraction and/or electrohydraulic lithotripsy; 3 cases required open vesicolithotomy and four calculi passed spontaneously. Complete stone extraction was achieved after a single endoscopic treatment in every case approached in this fashion. Every patient resumed preoperative voiding patterns and there were no infections, strictures, or other complications. Calculi reformed in 4 patients and were successfully managed endoscopically.
Conclusions:
An endoscopic approach to bladder calculi is a safe and effective method of managing this increasingly prevalent problem in children following augmentation cystoplasty even in the presence of a reconstructed bladder neck. Open vesicolithotomy should be reserved for the very large stone burden.