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Bladder calculi in the pediatric augmented bladder
K M Kronner1, A J Casale, M P Cain
1Department of Pediatric Urology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, USA.
Insights
Bladder augmentation in children can lead to bladder stones (calculi) in 10% of cases. Risk factors include outlet resistance and catheterizable stomas, but stomach augmentation showed no stone formation.
Area of Science:
- Pediatric Urology
- Surgical Innovation
Background:
- Bladder augmentation is a standard treatment for pediatric bladder anomalies.
- Bladder calculi (stones) are a significant complication, reported in 33-50% of cases.
Purpose of the Study:
- To determine the incidence of bladder calculi after bladder augmentation in children.
- To identify risk factors associated with stone formation.
- To review treatment modalities for bladder calculi.
Main Methods:
- Retrospective review of 286 pediatric patients undergoing bladder augmentation (1978-1994).
- Analysis of incidence, risk factors, and treatment outcomes for bladder calculi.
Main Results:
- Bladder calculi occurred in 10% (29/286) of patients.
- Stomach augmentation did not result in stone formation.
- Increased stone risk was linked to bladder outlet resistance and catheterizable abdominal wall stomas.
- Stone recurrence rate was 44% after cystolithotomy or cystolitholapaxy.
Conclusions:
- Bladder calculi are a common complication of pediatric bladder augmentation.
- Bladder outlet resistance and catheterizable stomas are key risk factors.
- Regular bladder irrigation and complete emptying may reduce stone formation.
Purpose:
Bladder augmentation is now a commonly accepted treatment in children with neuropathic bladder and other bladder anomalies. Bladder calculi have been reported in a third to a half of pediatric patients after bladder augmentation. We identify the incidence of bladder calculi and risk factors for stone formation in a large series of pediatric patients after bladder augmentation.
Materials And Methods:
We reviewed the records of 286 patients who underwent bladder augmentation between 1978 and 1994, assessed the incidence of and risk factors for bladder calculi, and reviewed treatment methods.
Results:
Bladder calculi developed in 29 of the 286 patients (10%) who underwent bladder augmentation. The type of bowel used for augmentation did not affect the rate of stone formation except stomach, which did not lead to stone formation in any case. Stones formed more commonly after bladder outlet resistance procedures and in patients with catheterizable abdominal wall stomas. Patients underwent open cystolithotomy or cystolitholapaxy with an overall 44% recurrence rate and no statistically significant difference between treatment methods.
Conclusions:
Bladder calculi are a known complication of bladder augmentation. An increased risk of stone formation is associated with bladder outlet resistance procedures and catheterizable abdominal wall stomas. Daily irrigations to clear mucus and crystals as well as complete emptying of the augmented bladder may have important roles in decreasing stone formation.