Elsevier

Urology

Volume 56, Issue 3, September 2000, Pages 482-487
Urology

Pediatric urology
Bladder calculi in augmentation cystoplasty in children

https://doi.org/10.1016/S0090-4295(00)00663-4Get rights and content

Abstract

Objectives. To determine the best preventive strategies for bladder calculi in children with an augmented bladder, the risk factors and prevention strategies for urolithiasis were evaluated.

Methods. The records of 89 patients following augmentation cystoplasty were reviewed to assess the results of augmentation cystoplasties and in particular the formation and prevention of calculi.

Results. The median follow-up was 4.9 years after augmentation. Most patients (71) had an ileocystoplasty. Bladder calculi occurred in 14 of the 89 patients (16%) and recurred in 4 patients. Girls had a higher incidence of urolithiasis. Other risk factors were cloacal malformations, vaginal reconstructions, anal atresia, clean intermittent catheterization problems and retention, bladder neck surgery, and symptomatic urinary tract infections.

Conclusions. Subgroups with cloacal malformations, vaginal reconstructions, ureter reimplantation, and bladder neck surgery were identified that have an increased risk for stone formation and therefore warrant special care in the follow-up after augmentation. This care should include clear emphasis on the role of treating symptomatic urinary tract infections, especially in patients with cloacal malformations and vaginal reconstructions. Girls have a higher incidence of bladder calculi than boys.

Section snippets

Material and methods

Between September 1987 and April 1998, 90 patients underwent surgery in order to obtain a high-volume, low-pressure bladder reservoir by bladder augmentation. The records of 89 patients could be reviewed. Augmentation cystoplasty was performed in 38 male and 51 female patients. The mean age was 14 years with a mean follow-up period of 4.9 years. The mean age at augmentation was 9.5 years (range 9 months to 24 years). The indications for augmentation are given in Table I.

Of the 89 patients, 44

Results

During the follow-up period 18 stones were found in 14 patients for the first time. In Table III different risk factors are listed. In 3 patients more than one type of stone was found at the first presentation with bladder calculi. Ammonium urate and calcium apatite stones occurred only with struvite stones. None of the stoneformers had a history of urolithiasis before augmentation. Two patients, who had had stones prior to augmentation cystoplasty, did not form stones after augmentation. In 1

Comment

Fourteen of our 89 patients formed 18 bladder calculi for the first time following augmentation. Infection stones were encountered most often. It is known that urinary infection, especially with P. mirabilis17 or other urease-producing bacteria, can cause bladder stone formation by changing urine and bladder mucus composition.5 In addition fimbriae, adhesins, and the glycocalyx have been suggested to increase bladder stone formation.18, 19, 20, 21 In this respect measures that remove bacteria

Conclusions

Infections of the augmented bladder are not benign. Girls are more prone to develop stones in enterocystoplasties, despite CIC. It is clear that concomitant surgical procedures, especially on the bladder neck, increase the risk of urolithiasis. Prophylactic use of antibiotics has no effect on the total number of stones, but seems to decrease the number of struvite stones. Congenital malformations and vaginal reconstructions are important risk factors, and we advise guarding against infections.

References (29)

  • D.A. Diamond et al.

    Etiological factors in pediatric stone recurrence

    J Urol

    (1989)
  • M.W. Bigelow et al.

    Calcium oxalate crystal attachment to cultured kidney epithelial cell lines

    J Urol

    (1998)
  • C.F. Verkoelen et al.

    Association of calcium oxalate monohydrate crystals with MCDK cells

    Kidney Int

    (1995)
  • A. Edin-Liljegren et al.

    Concrement formation and urease-induced crystallization in urine from patients with continent ileal reservoirs

    Br J Urol

    (1996)
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