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Urolithiasis in children following augmentation cystoplasty
L S Palmer1, I Franco, S J Kogan
1Division of Pediatric Urology, Albert Einstein College of Medicine, Bronx, New York.
Insights
Urinary stones (urolithiasis) are a common complication after augmentation cystoplasty in children, occurring in 52% of patients. Urinary tract infections and other factors increase the risk of stone formation, posing challenges for treatment.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Nephrology
Background:
- Urolithiasis following augmentation cystoplasty was previously uncommon.
- This study investigates a 10-year experience with this complication.
Purpose of the Study:
- To determine the incidence and characteristics of urinary calculi after augmentation cystoplasty in pediatric patients.
- To identify risk factors and analyze calculus composition.
- To evaluate management strategies for calculi in this population.
Main Methods:
- Retrospective review of 10-year surgical experience.
- Analysis of patient demographics, surgical procedures, and clinical outcomes.
- Assessment of urinary tract infection, biomaterials, and metabolic factors.
- Chemical analysis of calculus composition.
- Evaluation of endoscopic and surgical management outcomes.
Main Results:
- 52% of children and young adults developed urinary calculi post-augmentation cystoplasty.
- Calculi formed at a median of 24.5 months, primarily in the lower urinary tract.
- Significant risk factors included urinary tract infection, absorbable staples, intestinal mucus, and hypocitraturia.
- Calculus composition was mainly apatite, struvite, and ammonium urate.
- Bladder calculi were managed endoscopically; upper tract calculi presented challenges.
Conclusions:
- Augmentation cystoplasty is associated with a high incidence of urolithiasis in pediatric patients.
- Urinary tract infection is a key risk factor, necessitating proactive management.
- Endoscopic management is effective for bladder calculi, while upper tract stones require specialized urological intervention.
Abstract:
Until recently urolithiasis in children following augmentation cystoplasty was an infrequently noted problem. We examined our 10-year experience and found urinary calculi to form in 52% of children and young adults undergoing augmentation cystoplasty. Calculi formed at a median interval of 24.5 months after surgery, predominantly in the lower tract. Urinary tract infection was a statistically significant risk factor, while the use of absorbable staples, intestinal mucus and hypocitraturia were also implicated. Calculus composition was primarily a mixture of apatite, struvite and ammonium urate. Bladder calculi were effectively managed endoscopically in the majority of cases without complication. Upper tract calculi presented an endourological challenge.