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Burns R, Hardesty J, Schmidt J, Risk N, Vasquez R, Soyster M, Mellon M, Rivera M. Percutaneous Cystolitholapaxy Is Safe and Effective in Adult Patients With Lower Urinary Tract Reconstruction Utilizing Bowel. Urology 2023; 178:37-41. [PMID: 37150405 DOI: 10.1016/j.urology.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/13/2023] [Accepted: 04/27/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To investigate the safety, efficacy, and surgical approach of percutaneous bladder calculi removal in adult patients with prior lower urinary tract reconstruction utilizing bowel using a single-institution database. METHODS Twenty patients with prior history of lower urinary tract reconstruction (continent cutaneous urinary reservoir, augmentation enterocystoplasty with catheterizable channel, or ileal neobladder) who underwent percutaneous cystolitholapaxy from 2014 to 2020 were identified from an IRB-approved database. Analysis of patient demographics, operative details, stone composition, stone-free rates, recurrence, and associated complications was performed. RESULTS Percutaneous access and either ultrasonic lithotripter or laser lithotripsy were utilized to remove bladder stones. Over half of the patients also underwent concomitant renal stone removal via percutaneous removal or retrograde ureteroscopy. Postoperative computed tomography imaging revealed complete bladder stone clearance in 90% of patients. There were no notable complications from percutaneous bladder stone removal and most patients were discharged either the same day or within 24hours. Urine and stone analysis revealed infection was present in the majority of patients. Bladder stones recurred in 45% of patients after more than 2years of follow-up, on average. CONCLUSION Percutaneous cystolitholapaxy is a safe and effective approach for the removal of moderate-sized bladder calculi in adults with prior lower urinary tract reconstruction utilizing bowel. Its efficacy and minimally invasive nature make it the approach of choice at our institution.
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Affiliation(s)
- Ramzy Burns
- Department of Urology, Indiana University, Indianapolis, IN.
| | | | | | - Nathan Risk
- Indiana University School of Medicine, Indianapolis, IN
| | - Ruben Vasquez
- Department of Urology, Indiana University, Indianapolis, IN
| | - Mary Soyster
- Department of Urology, Indiana University, Indianapolis, IN
| | - Matthew Mellon
- Department of Urology, Indiana University, Indianapolis, IN
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Complications of Pediatric Bladder Reconstruction in the Adult Patient. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00584-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3
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Abstract
Surgical indications for individuals with neuropathic bladder include unsafe urinary storage pressures, progressive upper tract deterioration, and continued urinary incontinence that is recalcitrant to oral pharmacologic or intradetrusor injection therapy and intermittent catheterization. Bladder augmentation is currently the gold standard surgical procedure used to increase bladder capacity and reduce storage pressures but has significant long-term risks. The medical and surgical management of neuropathic bladder, as well as long-term consequences of bladder augmentation, are reviewed.
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Affiliation(s)
- Joshua D Roth
- Department of Pediatric Urology, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN 46202, USA.
| | - Mark P Cain
- Department of Pediatric Urology, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN 46202, USA
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Abstract
There are several special situations in which urinary lithiasis presents management challenges to the urologist. An in-depth knowledge of the pathophysiology, unique anatomy, and treatment options is crucial in order to maintain good health in these patients. In this review, we summarize the current literature on the management of the following scenarios: bladder stones, stones in bowel disease, during pregnancy, in association with renal anomalies, with skeletal deformities, in urinary diversions, and in children.
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Telli O, Gollu G, Khanmammadov F, Tastekin NY, Aktug T. Urethral Calculi in a 7-Year-old Boy Presenting as a Large Scrotal Mass After Surgery of Exstrophy-epispadias Repair. Urology 2015. [PMID: 26199152 DOI: 10.1016/j.urology.2015.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Urethral calculi are extremely rare in pediatric population and are usually presented with dysuria, hematuria, lower urinary tract obstruction, and rarely as a scrotal mass. We here report a giant primary urethral stone presenting as a scrotal mass that developed in the penile urethra resulting from a postsurgical complication of exstrophy-epispadias repair. A 7-year-old boy was admitted with the complaint of scrotal mass and dysuria. Computerized tomography confirmed giant urethral stone impacted to diverticulum of urethra. Cystoscopy revealed a nonobstructed stone in the urethra related to a posterior diverticulum. After scrotal incision, stone was removed with open diverticulectomy.
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Affiliation(s)
- Onur Telli
- Department of Pediatric Urology, School of Medicine, Ankara University, Ankara, Turkey.
| | - Gulnur Gollu
- Department of Pediatric Surgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Farid Khanmammadov
- Department of Pediatric Surgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Nil Yasam Tastekin
- Department of Pediatric Surgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Tanju Aktug
- Department of Pediatric Surgery, School of Medicine, Ankara University, Ankara, Turkey
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Helmy TE, Elawdy MM, AbdelHalim A, Orban H, Nabeeh H, Dawaba M, Hafez AT. Treatment of pouch stones after augmentation ileocystoplasty in children: is it always bothersome? Urology 2014; 85:195-8. [PMID: 25444630 DOI: 10.1016/j.urology.2014.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 09/06/2014] [Accepted: 09/16/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To report our experience with different approaches for management of pouch stones in children with ileal-based urinary reservoir. PATIENTS AND METHODS Charts of children who underwent ileal-based urinary reservoirs between 2000 and 2009 were retrospectively reviewed. Patients who were diagnosed with reservoir calculi were identified; medical records were reviewed for patients' demographics, diversion details, stone criteria, mode of treatment, perioperative complications, and recurrence rate. RESULTS We identified 26 children with pouch stones after urinary diversion. There were 11 boys (42%) and 15 girls (58%). Mean age was 11 years (range, 4-16 years). Mean time for diagnosis was 42 months (24-120 months). Pouch stones were asymptomatic in 10 patients (38%). Fifteen cases were postbladder augmentation and 11 cases postcontinent cutaneous diversion. The mean stone size was 4 cm (range, 1-10 cm), and mean Hounsfield Unit was 585 (205-1090). Seventeen children (65%) had positive urine culture result, whereas 9 children were sterile. Seven children (27%) required open poucholithotomy, whereas 19 patients (73%) were managed endoscopically. Percutaneous approach was done in 5 children, whereas urethral access was used in 7 children. Mechanical extraction was performed in 12 cases, and stone disintegration was required in 7 cases. Eight children developed stone recurrence. Mean time for recurrence was 11 months (range, 3-19 months). Six children were after endoscopic disintegration, and all required redo endoscopic extraction. Stone analysis was available in 15 patients (struvite stones in 10 cases and calcium phosphate in 5 cases). CONCLUSION Pouch stones are established long-term complication of urinary diversion. Open and endoscopic approaches are valid treatment strategies.
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Affiliation(s)
- Tamer E Helmy
- Department of Pediatric Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
| | - Mohammed M Elawdy
- Department of Pediatric Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed AbdelHalim
- Department of Pediatric Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Hesham Orban
- Department of Pediatric Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Hossam Nabeeh
- Department of Pediatric Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mohammed Dawaba
- Department of Pediatric Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ashraf T Hafez
- Department of Pediatric Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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8
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Long-Term Outcomes Following Bladder Augmentation in Children with Neurogenic Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0268-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Szymanski KM, Misseri R, Whittam B, Amstutz S, Kaefer M, Rink RC, Cain MP. Cutting for Stone in Augmented Bladders—What is the Risk of Recurrence and is it Impacted by Treatment Modality? J Urol 2014; 191:1375-80. [DOI: 10.1016/j.juro.2013.11.057] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Konrad M. Szymanski
- Riley Hospital for Children, Indiana University–Purdue University Indianapolis, Indianapolis, Indiana
| | - Rosalia Misseri
- Riley Hospital for Children, Indiana University–Purdue University Indianapolis, Indianapolis, Indiana
| | - Benjamin Whittam
- Riley Hospital for Children, Indiana University–Purdue University Indianapolis, Indianapolis, Indiana
| | - Sable Amstutz
- Riley Hospital for Children, Indiana University–Purdue University Indianapolis, Indianapolis, Indiana
| | - Martin Kaefer
- Riley Hospital for Children, Indiana University–Purdue University Indianapolis, Indianapolis, Indiana
| | - Richard C. Rink
- Riley Hospital for Children, Indiana University–Purdue University Indianapolis, Indianapolis, Indiana
| | - Mark P. Cain
- Riley Hospital for Children, Indiana University–Purdue University Indianapolis, Indianapolis, Indiana
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Percutaneous cystolithotomy in the pediatric neuropathic bladder with laparoscopic trocar access: a modified approach useful for the augmented and native bladder, and continent urinary reservoir. J Pediatr Urol 2013; 9:289-92. [PMID: 22795187 DOI: 10.1016/j.jpurol.2012.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 05/06/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We present our results of percutaneous cystolithotomy with laparoscopic trocar (PCLT) access in children. MATERIALS AND METHODS PCLT was performed in 13 cases. This includes 2 patients who had this performed twice for recurrent stone 12-24 months after initial surgery. Eight patients had a bladder augmentation, 2 had native bladders, and one a continent urinary reservoir. Nine patients had a reconstructed urethra. Cystoscopy was performed in all cases to assess stone burden. Under direct vision, an 18 gauge angiocatheter was placed into bladder and guidewire placed through the angiocatheter. With the bladder distended, a laparoscopic 10 mm trocar was placed under vision next to the guidewire. A 26Fr nephroscope was used via the trocar to extract the stones, utilizing laser or ultrasonic lithotripsy to fragment larger stones. Stone fragments were removed with graspers and/or the vacuum extraction technique. RESULTS PCLT was successful in all cases. No complications were noted. Six cases were treated as outpatient, seven discharged home after 12-23 h observation. CONCLUSIONS PCLT via laparoscopic trocar access is a facile and safe approach for removing stones in the pediatric neuropathic bladder. Advantages include the ability to distend the bladder with continuous flow and the larger working channel permitting use of the nephroscope to treat and extract stones.
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11
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Breda A, Mossanen M, Leppert J, Harper J, Schulam PG, Churchill B. Percutaneous Cystolithotomy for Calculi in Reconstructed Bladders: Initial UCLA Experience. J Urol 2010; 183:1989-93. [DOI: 10.1016/j.juro.2010.01.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Alberto Breda
- Division of Endourology, Department of Urology, University of California, Los Angeles, California
| | - Matthew Mossanen
- Division of Endourology, Department of Urology, University of California, Los Angeles, California
| | - John Leppert
- Division of Urologic Oncology, Department of Urology, Stanford School of Medicine, San Francisco, California
| | - Jonathan Harper
- Division of Endourology, Department of Urology, University of California, Los Angeles, California
| | - Peter G. Schulam
- Division of Endourology, Department of Urology, University of California, Los Angeles, California
| | - Bernard Churchill
- Division of Pediatric Urology, Department of Urology, University of California, Los Angeles, California
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12
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Shimotakahara A, Kato Y, Lane GJ, Yamataka A. Postoperative cystolithiasis in a case of cloacal malformation treated using an endoscopic pneumatic lithotripter through a combination of percutaneous and transurethral approaches. J Laparoendosc Adv Surg Tech A 2009; 19 Suppl 1:S159-60. [PMID: 19215208 DOI: 10.1089/lap.2008.0140.supp] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Long-term management of patients with cloacal malformation is still challenging to pediatric surgeons and urologists. Recently, we experienced postoperative cystolithiasis in a case of cloacal malformation. All stones were removed successfully by using an endoscopic pneumatic lithotripter through a combined approach from the cystostomy and the narrow reconstructed urethra. To the best of our knowledge, this was the first time for this combined approach to be applied in a patient with cloacal malformation. It has a particular appeal because it is simple, safe, and minimally invasive.
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Affiliation(s)
- Akihiro Shimotakahara
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
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Paez E, Reay E, Murthy LNS, Pickard RS, Thomas DJ. Percutaneous Treatment of Calculi in Reconstructed Bladder. J Endourol 2007; 21:334-6. [PMID: 17444782 DOI: 10.1089/end.2006.0251] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To report our results with percutaneous removal of calculi from reconstructed bladders. PATIENTS AND METHODS Twelve patients with reconstructed bladders who underwent endoscopic cystolithotomy were identified from our departmental database, and retrospective review of case notes and imaging was performed. RESULTS Access was gained via an ultrasound-guided new tract in 9 patients (75%). An old suprapubic tract site was used in two patients, and the Mitrofanoff stoma was the route of access in one patient. The procedure was successful, with stone clearance achieved in all 12 cases. No major complications were observed. At a median follow up of 24 months, stone recurrence was observed in 5 patients (42%), 4 of whom underwent repeat procedures. Follow-up showed no change in continence in the patient with a Mitroffanoff stoma. CONCLUSION Percutaneous cystolithotomy is a safe and effective minimally invasive option for removal of stones in a reconstructed bladder. We recommend endoscopic removal as the treatment of choice in these patients.
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Affiliation(s)
- Edgar Paez
- Department of Urology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
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14
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Lam PN, Te CC, Wong C, Kropp BP. Percutaneous Cystolithotomy of Large Urinary-Diversion Calculi Using a Combination of Laparoscopic And Endourologic Techniques. J Endourol 2007; 21:155-7. [PMID: 17338612 DOI: 10.1089/end.2006.0238] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Patients with urinary diversions are at higher risk for bladder urolithiasis. Often, the stone burden is large, necessitating open stone removal. We describe our technique for removing such stones using a combination of laparoscopic and endourologic instrumentation. PATIENTS AND METHODS With the patient in the dorsal lithotomy position or supine, cystoscopy is performed via the native urethra or catheterizable stoma, respectively. With the urinary reservoir distended with normal saline, percutaneous access is obtained under direct vision with a 10-mm trocar introduced through the scar of the previous suprapubic cystostomy. A laparoscopic entrapment bag is introduced through the trocar, into which the calculi are manipulated. The bag is delivered percutaneously through the trocar site with subsequent removal of the trocar. A 30F Amplatz renal dilator sheath (Cook Urological, Spencer, IN) is introduced directly into the bag. An ultrasonic lithotrite passed through a nephroscope is utilized to fragment and evacuate the calculi. Closure of the neocystotomy is not performed. A drainage catheter is left in for 7 days. RESULTS This procedure has been successful in eight consecutive patients, six with bladder augmentations, one with a bladder reconstruction with appendicovesicostomy, and one with an Indiana pouch. All calculi were radiopaque, having a mean linear size of 4.1 cm (range 1.5-7.0) cm. Several patients had multiple stones. The mean operating room time was 123 minutes (range 48-228 minutes). Two patients had concomitant ureteroscopy with laser lithotripsy for ureteral calculi. All were rendered stone free with one procedure and were discharged within 23 hours after surgery. There were no immediate or delayed complications. CONCLUSIONS Our technique of percutaneous cystolithotomy utilizing laparoscopic and endourologic instrumentation is safe and effective for the removal of large calculi from urinary diversions. It is well tolerated, allows complete stone removal in a single sitting, and obviates an open procedure.
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Affiliation(s)
- Po N Lam
- Department of Urology, University of Oklahoma, Oklahoma City, Oklahoma 73104, USA
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Single percutaneous access for endoscopic extraction of lithiasis after intestinocystoplasty. J Pediatr Urol 2006; 2:564-8. [PMID: 18947682 DOI: 10.1016/j.jpurol.2006.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Accepted: 01/16/2006] [Indexed: 11/23/2022]
Abstract
PURPOSE Bladder-stone formation is a common problem following augmentation cystoplasty. Urological management is controversial. We describe a minimally invasive technique using electrohydraulic vesicolithotripsy via a single percutaneous access. MATERIAL AND METHODS Between 1998 and 2004, 10 percutaneous extractions of bladder calculi were performed in seven patients with bladder augmentation. Prior bladder enlargement was performed for neuropathic bladder dysfunction in four cases and bladder exstrophy in three cases. The procedure involved percutaneous placement of a 10- or 12-mm laparoscopic trocar, after which the airtightness valve of the trocar was removed. A rigid nephroscope allowed direct visualization of calculi. Stones were fragmented with electrohydraulic lithotripsy when necessary. Removal of the fragments was by grasping forceps or basket. Vigorous, warmed-saline bladder irrigation eliminated residual fragments. RESULTS The technique was successful in all cases, resulting in controlled bladder-stone-free status and no surgical complications. The only complication was hypothermia linked to prolonged operation time, inadequate warmed-saline irrigation and lack of waterproof sheets. CONCLUSIONS Percutaneous vesicolithotripsy was highly successful and easy to perform, without being restricted by size and number of calculi. The continence mechanism of a reconstructed urethra or Mitrofanoff conduit should not be compromised. As recurrent stone formation is expected in children with augmented bladder, this technique appears to be suitable for bladder calculi removal during the long-term follow-up of multioperated patients.
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Yalcin V, Alan C, Onder AU, Demirkesen O, Kalkan M. Pneumatic lithotripter application for giant bladder stone in a patient with augmentation cystoplasty. J Endourol 2004; 18:491-2. [PMID: 15253829 DOI: 10.1089/0892779041271436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
An 18-year-old patient with repaired bladder exstrophy developed a 550-g stone burden in his augmented bladder. The stones were removed percutaneously with the aid of a pneumatic lithotripter. This should be considered the method of choice in these difficult cases.
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Affiliation(s)
- Veli Yalcin
- Department of Urology, University of Istanbul, Cerrahpaşa School of Medicine, Bolu, Turkey
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Editorial comment. Urology 2003. [DOI: 10.1016/s0090-4295(03)00457-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cain MP, Casale AJ, Kaefer M, Yerkes E, Rink RC. Percutaneous Cystolithotomy in the Pediatric Augmented Bladder. J Urol 2002. [DOI: 10.1016/s0022-5347(05)64435-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Mark P. Cain
- From the Department of Urology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
| | - Anthony J. Casale
- From the Department of Urology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
| | - Martin Kaefer
- From the Department of Urology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
| | - Elizabeth Yerkes
- From the Department of Urology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
| | - Richard C. Rink
- From the Department of Urology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
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Abstract
PURPOSE We review our initial cases of continent cystostomy to assess long-term functional results and complications after a minimum of 15 years of followup. MATERIALS AND METHODS Between 1976 and 1984, 23 continent cystostomies were performed on 15 boys and 8 girls with neuropathic bladders. Mean patient age at surgery was 8 years and 4 months (range 3 to 16) and mean followup was 20 years (range 15 to 23). The neurological lesions were due to 21 myelomeningocele (2 associated with an imperforated anus in 21 cases), spinal neuroblastoma in 1 and complex genitourinary malformation associated with an imperforated anus in 1. Closure of the bladder neck was performed in 21 cases (16 during the same procedure, 5 secondarily) and 2 did not undergo this procedure. The appendix was used as the catheterizable conduit in 20 cases, 1 ureter in 2 and a bladder tube in 1. Bladder augmentation was performed during the same procedure in 2 cases and at a later stage in 8. Five patients presented with unilateral or bilateral secondary vesicoureteral reflux. RESULTS One death occurred after conversion to cutaneous diversion due to a postoperative infection leading to a ventriculoperitoneal valve infection. The remaining 22 patients were followed every 6 to 12 months. No metabolic disorder, secondary malignancy or spontaneous bladder perforation was noted. Bilateral upper tract deterioration was found in 10 cases leading to secondary bladder augmentation by enterocystoplasty in 6 and creation of noncontinent diversion in 4. Leakage occurred after bladder neck closure in 5 patients. Bladder stones were found in 5 patients (2 had prior bladder augmentation). Complications related to the conduit included stomal stenosis or persistent leakage in 11 cases, which required surgical revision and/or repeated dilations and 1 noncontinent diversion after revision failure. Five patients presented with intestinal occlusion due to volvulus in 3 and adhesion in 2. We noted that after 10 years of followup complications were rare and concerned mostly the catheterizable conduit. Therefore, 16 patients had a good and stable result while 6 have noncontinent diversion. CONCLUSIONS The rate of complications has a tendency to decrease with time. The results obtained in this series may appear less satisfactory than those of more recent series, which may be due to the fact that these oldest continent cystostomies correspond to acquisition of experience of this novel approach, and to a period when the concept of low pressure reservoir was not yet established and bladder augmentations were not routinely performed. Since 1984 no continent cystostomy performed at our institution was converted into a noncontinent diversion. This series with long followup demonstrates that continent cystostomy is a procedure with lasting efficiency.
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Affiliation(s)
- A Liard
- Department of Pediatric Surgery, University Hospital Charles Nicolle, Rouen, France
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Abstract
PURPOSE We review our initial cases of continent cystostomy to assess long-term functional results and complications after a minimum of 15 years of followup. MATERIALS AND METHODS Between 1976 and 1984, 23 continent cystostomies were performed on 15 boys and 8 girls with neuropathic bladders. Mean patient age at surgery was 8 years and 4 months (range 3 to 16) and mean followup was 20 years (range 15 to 23). The neurological lesions were due to 21 myelomeningocele (2 associated with an imperforated anus in 21 cases), spinal neuroblastoma in 1 and complex genitourinary malformation associated with an imperforated anus in 1. Closure of the bladder neck was performed in 21 cases (16 during the same procedure, 5 secondarily) and 2 did not undergo this procedure. The appendix was used as the catheterizable conduit in 20 cases, 1 ureter in 2 and a bladder tube in 1. Bladder augmentation was performed during the same procedure in 2 cases and at a later stage in 8. Five patients presented with unilateral or bilateral secondary vesicoureteral reflux. RESULTS One death occurred after conversion to cutaneous diversion due to a postoperative infection leading to a ventriculoperitoneal valve infection. The remaining 22 patients were followed every 6 to 12 months. No metabolic disorder, secondary malignancy or spontaneous bladder perforation was noted. Bilateral upper tract deterioration was found in 10 cases leading to secondary bladder augmentation by enterocystoplasty in 6 and creation of noncontinent diversion in 4. Leakage occurred after bladder neck closure in 5 patients. Bladder stones were found in 5 patients (2 had prior bladder augmentation). Complications related to the conduit included stomal stenosis or persistent leakage in 11 cases, which required surgical revision and/or repeated dilations and 1 noncontinent diversion after revision failure. Five patients presented with intestinal occlusion due to volvulus in 3 and adhesion in 2. We noted that after 10 years of followup complications were rare and concerned mostly the catheterizable conduit. Therefore, 16 patients had a good and stable result while 6 have noncontinent diversion. CONCLUSIONS The rate of complications has a tendency to decrease with time. The results obtained in this series may appear less satisfactory than those of more recent series, which may be due to the fact that these oldest continent cystostomies correspond to acquisition of experience of this novel approach, and to a period when the concept of low pressure reservoir was not yet established and bladder augmentations were not routinely performed. Since 1984 no continent cystostomy performed at our institution was converted into a noncontinent diversion. This series with long followup demonstrates that continent cystostomy is a procedure with lasting efficiency.
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Affiliation(s)
- A Liard
- Department of Pediatric Surgery, University Hospital Charles Nicolle, Rouen, France
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22
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Barroso U, Jednak R, Fleming P, Barthold JS, González R. Bladder calculi in children who perform clean intermittent catheterization. BJU Int 2000; 85:879-84. [PMID: 10792170 DOI: 10.1046/j.1464-410x.2000.00625.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine the role of clean intermittent catheterization (CIC) as a possible predisposing risk factor for bladder calculi, assessing risk factors in patients with and without bladder augmentation, and to evaluate management options for bladder calculi in these patients. PATIENTS AND METHODS The records of 403 patients who were using a regimen of CIC between January 1981 and March 1998 were reviewed to identify those forming bladder calculi; stones were diagnosed in 28 patients. The patients were categorized as: group 1, patients with no bladder augmentation who catheterized urethrally (227, group 1a) or via a Mitrofanoff conduit (18, group 1b); group 2, patients with augmented bladders who catheterized urethrally (100, group 2a) or via a Mitrofanoff conduit (58, group 2b). The incidence of bladder calculi in each group was determined and compared statistically where applicable. The success of the treatment options for stone management was reviewed. RESULTS Bladder calculi developed in 5% of patients in group 1a, 8% in group 2a, 11% in group 1b, and 10% in group 2b; the incidence of calculi was not significantly different among the groups. Of these patients, 18 (64%) were asymptomatic at the time of diagnosis and significant bacteriuria was found in 23 (88%). Difficulty in catheterizing either the Mitrofanoff conduit or the native urethra was reported in 14 (50%) of these patients. Calculi were more often solitary (71%) and typically composed of struvite or apatite. Calculi were managed by open cystolithotomy in 15 patients (54%) and endoscopically in 13 (46%). Stones recurred in nine patients (32%) after treatment, comprising four of six patients treated endoscopically with electrohydraulic lithotripsy and in five of 15 after open cystolithotomy. The mean interval to recurrence was 22.8 months. CONCLUSION These results suggest that patients on a regimen of CIC are at risk of developing bladder calculi but the incidence of calculi is not influenced by bladder augmentation. The presence of a Mitrofanoff conduit was associated with a slightly increased incidence of calculus formation. Open cystolithotomy was associated with a lower stone recurrence rate but there were too few patients to draw definitive conclusions.
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Affiliation(s)
- U Barroso
- Department of Paediatric Urology, Children's Hospital of Michigan and Wayne State University School of Medicine, Detroit, Michigan, USA
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Abstract
Bladder calculi account for 5% of urinary calculi and usually occur because of foreign bodies, obstruction, or infection. Males with prostate disease or previous prostate surgery and women who undergo anti-incontinence surgery are at higher risk for developing bladder calculi. Patients with SCI with indwelling Foley catheters are at high risk for developing stones. There appears to be a significant association between bladder calculi and the formation of malignant bladder tumors in these patients. Transplant recipients are not at increased risk for developing vesical calculi in the absence of intravesical suture fragments and other foreign bodies. Patients who undergo bladder-augmentation procedures using a vascularized gastric patch appear to be protected from vesicolithiasis, perhaps by the acidic environment. Ileum and colon tissues, however, are colonized by urease-producing organisms, producing an alkaline pH that promotes stone formation. Children remain at high risk for bladder-stone development in endemic areas. Diet, voiding dysfunction, and uncorrected anatomic abnormalities, such as posterior urethral valves and vesicoureteral reflux, predispose them to bladder-calculus formation. Finally, there are a number of techniques and modalities available to remove bladder stones. Relieving obstruction, eliminating infection, meticulous surgical technique, and accurate diagnosis are essential in their treatment.
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Affiliation(s)
- B F Schwartz
- Department of Urology, MCHK-DSU, Honolulu, Hawaii
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Affiliation(s)
- Selwyn B. Levitt
- Schneider Children's Hospital; Long Island Jewish Medical Center; New Hyde Park, New York
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EDITORIAL. J Urol 1998. [DOI: 10.1097/00005392-199812010-00081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kronner KM, Casale AJ, Cain MP, Zerin MJ, Keating MA, Rink RC. Bladder calculi in the pediatric augmented bladder. J Urol 1998; 160:1096-8; discussion 1103. [PMID: 9719284 DOI: 10.1097/00005392-199809020-00035] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- K M Kronner
- Department of Pediatric Urology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, USA
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PALMER LANES, PALMER JEFFREYS, FIRLIT BARBARAM, FIRLIT CASIMIRF. RECURRENT UROLITHIASIS AFTER AUGMENTATION GASTROCYSTOPLASTY. J Urol 1998. [DOI: 10.1016/s0022-5347(01)63610-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- LANE S. PALMER
- Division of Urology, Children's Memorial Medical Center, Northwestern University Medical School and University of Chicago, Chicago, Illinois
| | - JEFFREY S. PALMER
- Division of Urology, Children's Memorial Medical Center, Northwestern University Medical School and University of Chicago, Chicago, Illinois
| | - BARBARA M. FIRLIT
- Division of Urology, Children's Memorial Medical Center, Northwestern University Medical School and University of Chicago, Chicago, Illinois
| | - CASIMIR F. FIRLIT
- Division of Urology, Children's Memorial Medical Center, Northwestern University Medical School and University of Chicago, Chicago, Illinois
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RECURRENT UROLITHIASIS AFTER AUGMENTATION GASTROCYSTOPLASTY. J Urol 1998. [DOI: 10.1097/00005392-199804000-00083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE We sought to determine the incidence of urolithiasis in patients with the exstrophy-epispadias complex, associated risk factors and guidelines for the proper clinical management of this problem. MATERIALS AND METHODS We retrospectively reviewed the chart and x-rays of 530 patients with the exstrophy-epispadias complex treated at our institution. RESULTS Stones formed in 77 of the 530 patients (15%), including 16% of those with classic exstrophy, 25% of those with cloacal exstrophy and 3% of those with epispadias. White and male individuals were most commonly affected. Most calculi formed in the bladder, whether native or augmented by enterocystoplasty. Standard techniques were successful for stone removal. Most calculi consisted of calcium apatite, calcium oxalate monohydrate or magnesium ammonium phosphate, usually in combination with at least 1 other element. The risk of stone formation was associated with augmentation cystoplasty (p < 0.001) and a bladder neck procedure to increase outlet resistance (p < 0.001). Other risk factors included urinary tract infection, foreign bodies, vesicoureteral reflux and urinary stasis but not acidosis or immobilization. Stones recurred in 30 patients (39%), including equal numbers of those treated with open and closed techniques, and recurrence was associated with urinary tract infection or struvite composition (p < 0.05). Serum calcium abnormalities were not present in any patient, including those with metabolic acidosis or prolonged immobilization. Urinary chemistry studies were incomplete or unavailable. CONCLUSIONS These data suggest that urolithiasis in the exstrophy-epispadias complex is related to risk factors associated with surgical reconstruction of this condition. The role of metabolic abnormalities that may predispose to urolithiasis is unknown but under investigation. Standard treatment is effective but stone recurrence remains a significant problem. Urine chemistry data may provide information to help minimize stone development in this patient population.
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Affiliation(s)
- R I Silver
- Division of Pediatric Urology, Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Affiliation(s)
- Richard I. Silver
- From the Division of Pediatric Urology, Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland
| | - David-Alexandre C. Gros
- From the Division of Pediatric Urology, Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland
| | - Robert D. Jeffs
- From the Division of Pediatric Urology, Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland
| | - John P. Gearhart
- From the Division of Pediatric Urology, Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland
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Abstract
Urolithiasis in childhood is of diverse etiology requiring carefully planned individualized diagnostic and management protocols. The efficiency in diagnosis and management of urolithiasis in childhood follows a learning curve, especially when using the more recent technical innovations for management of urinary calculi. With current technical sophistication of transurethral and percutaneous techniques and ESWL, management of urolithiasis during childhood should be relatively straightforward as monotherapy using a single modality or as a combined approach with one or more techniques, saving open surgical intervention for situations where the new technology is either unavailable or inappropriate, or when surgical reconstruction of the urinary tract is necessary to forestall recurrent calculus formation. Postoperative morbidity after management of urinary calculi during childhood appears insignificant; calculus recurrence is uncommon. Long-term postoperative follow-up is mandatory, especially after using the newer technical innovations for urinary calculus management during childhood.
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Affiliation(s)
- R L Kroovand
- Department of Urology, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina, USA
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Affiliation(s)
- T D Cohen
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
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