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Urology. 2015 Jan;85(1):195-8. doi: 10.1016/j.urology.2014.09.021. Epub 2014 Nov 12.

Treatment of pouch stones after augmentation ileocystoplasty in children: is it always bothersome?

Author information

1
Department of Pediatric Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. Electronic address: drthelmy@yahoo.com.
2
Department of Pediatric Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

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.

PMID:
25444630
DOI:
10.1016/j.urology.2014.09.021
[Indexed for MEDLINE]

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