[39] Management of pouch stones in a paediatric cohort: Single-centre experience
Objective: To report our experience with different approaches for management of pouch stones in children with an ileal-based urinary reservoir. Methods: A retrospective review was performed through our electronic database of children who underwent ileal-based urinary reservoirs between 2000 and 2009...
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| Autores principales: | , , , , |
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| Formato: | article |
| Lenguaje: | EN |
| Publicado: |
Taylor & Francis Group
2018
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| Materias: | |
| Acceso en línea: | https://doaj.org/article/6bea8dc082184443820f1294a3b9969b |
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| Sumario: | Objective: To report our experience with different approaches for management of pouch stones in children with an ileal-based urinary reservoir. Methods: A retrospective review was performed through our electronic database of children who underwent ileal-based urinary reservoirs between 2000 and 2009. Patients who were diagnosed with reservoir calculi were identified. Perioperative medical records were reviewed for patients’ demographics, diversion details, stone criteria, mode of treatment, complications, and recurrence rate. Results: In all, there were 26 patients with pouch stones [11 boys (42%) and 15 girls (58%)], with a mean (range) age of 11 (4–16) years. The main presentation was incidentally discovered in 10 patients (39%), haematuria in nine (34%), pain in six (23%), and urinary retention in one (4%). In all, 15 cases were post bladder augmentation and 11 post bladder neck closure augmentation ileocystoplasty and continent cutaneous outlet. All cases underwent urinary diversion for non-malignant causes. The mean (range) stone size was 4 (1–10) cm and mean (range) HU was 672 (205–1091). In all, 22 children had positive urine cultures, whilst four were sterile. Nine (35%) children required open poucholithotomy, whilst 17 (65%) were managed endoscopically. A percutaneous approach was used in eight children and urethral access was used in nine. Mechanical extraction was performed in seven children and stone disintegration was required in 10. Pouch injury occurred in two children, which required prolonged catheterisation. Six children developed stone recurrence after 3–12 months, all were after endoscopic disintegration and all required redo endoscopic extraction. Conclusion: Pouch stone is an established long-term complication of urinary diversion. Open and endoscopic approaches are feasible in this cohort, but the recurrence rate is high with the endoscopic approach. |
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