Preventing reservoir calculi after augmentation cystoplasty and continent urinary diversion: the influence of an irrigation protocol

Abstract

OBJECTIVETo evaluate the influence of an irrigation protocol in preventing reservoir calculi forming after augmentation cystoplasty and continent urinary diversion. 1985 and 1995, 91 patients had an augmentation cystoplasty and/or continent urinary diversion (group 1; 54 females and 37 males, mean age 11.1 years, range 1-31); these patients were not routinely instructed to use irrigation after surgery. The segments used included ileum (44), colon (36), stomach (eight) and ureter (three). Between 1995 and 2000, 42 patients (group 2) underwent urinary reconstruction (22 females and 20 males, mean age 14.8 years, range 4-27), the segment used being ileum (30), colon (five), ureter (five) and stomach (two) but in contrast to group 1 they then were placed on a standard prophylactic irrigation protocol. The occurrence of stones in the reservoir was then assessed. PATIENTS AND METHODS Between RESULTSThirty-nine of the 91 patients (42.8%) in group 1 presented with reservoir calculi after reconstruction and 22 had several episodes. The mean time to presentation was 30 months. The incidence of stone formation by underlying diagnosis included: myelomeningocele, 32/48 (66%), exstrophy five/25 (25%), posterior urethral valves two/20 (10%) and rhabdomyosarcoma, none of three. Fifty of the 91 patients had an abdominal stoma, with stone formation in 33 (66%), while 41 used the native urethra, with stone formation in six (15%). Three (7%) of the 42 patients in group 2 developed reservoir calculi after reconstruction, two in patients with myelomeningocele and one in a trauma patient who had residual bone spicules in the bladder; the mean time to presentation was 26.5 months. CONCLUSIONSThese data suggest that the irrigation protocol used in group 2 significantly reduced the number of reservoir calculi after urinary tract reconstruction when bowel was used as part of the reconstruction (43% vs. 7%). The most calculi in both groups were in immobile patients with sensory impairment. Also, patients with an abdominal stoma had a greater risk of reservoir calculi (66%) than those using the native urethra (15%).

CUA Guideline: Management of ureteral calculi

“…These include increased fluid intake, timed voiding or frequent clean intermittent catheterization, and frequent irrigation of reservoirs. 129 Metabolic workup to identify correctable risk factors, medical management of metabolic consequences of diversion, and long-term antibiotic prophylaxis against recurrent infections are also important to reduce recurrence. 125 Also of importance, the urologist should consider the possibility of anastomotic stricture or recurrent malignancy when stones are lodged near the uretero-enteric anastomosis.…”

Urologic care of adults with spina bifida

“…The latter study detects renal deterioration/hydronephrosis but also screens for the development of calculi. This is particularly important for those who previously underwent enterocystoplasty [13].…”

“…These patients are more likely to have remained under close surveillance with annual imaging of the upper and lower urinary tract. However, they may present with complications of prior surgery, including bladder and renal calculi, stenosis of continent catheterizable channels, or potentially lethal problems such as rupture of the neobladder [3,13]. These are discussed in more detail subsequently.…”

Litiasis urinaria en adultos con mielomeningocele

“…Kondo demostró que la litiasis vesical era 10 veces más prevalente en los pacientes con MMC portadores de enterocistoplastia 5 . Esta formación de cálculos en la vejiga ampliada, favorecida en los pacientes inmóviles con déficit sensoriales, desciende significativamente si se adoptan protocolos de irrigación 10 . En nuestra serie también fue origen de litiasis vesical, la persistencia de una prótesis de incontinencia afuncionante, o de algunos de sus componentes.…”