title: Cutting for stone in augmented bladders-what is the risk of recurrence and is it impacted by treatment modality?
abstract: OBJECTIVE
  Bladder stones are common after bladder augmentation, often resulting in numerous procedures for recurrence. We sought to determine whether surgical technique and stone fragmentation are significant predictors of bladder stone recurrence after bladder augmentation.
  
  
  METHODS
  We retrospectively reviewed 107 patients treated for first bladder stones at our institution. Patient demographics, details of surgeries, stone therapy and recurrence were reviewed. Kaplan-Meier survival and Cox proportional hazards analysis were used to determine predictors of time to first stone recurrence.
  
  
  RESULTS
  Of 107 patients 55.1% were female and 79.4% had neuropathic bladder. Patients underwent augmentation at a median age of 8.0 years (range 2.4 to 22.8) and were followed for a median of 12.4 years (1.8 to 34). Segments used for augmentation included ileum (72.9% of cases), sigmoid (16.8%), cecum/ileocecum (9.4%) and other (ureter, stomach/ileum, 1.8%). Bladder neck procedures were performed in 63.6% of patients and catheterizable channels in 75.7%. First stone surgery occurred at a median of 3.1 years after augmentation (range 5 months to 21.8 years). Endoscopy was used in 66.4% of cases and open cystolithotomy in 33.6%. Overall 47.7% of stones were fragmented. Bladder stones recurred in 47.7% of patients (median recurrence time 9.5 years, range 3 months to 14.7 years). Recurrence risk was greatest in the first 2 years postoperatively (12.1% per patient per year, p = 0.03). Recurrence risk did not change with technique (endoscopic vs open) or fragmentation, even after controlling for surgical and clinical variables.
  
  
  CONCLUSIONS
  Bladder stones recurred in almost half of the patients at 9 years postoperatively independent of treatment technique and patient characteristics. As a high risk group, yearly x-ray of the kidneys, ureters and bladder, and ultrasound of the kidneys and bladder are recommended in these patients.
authors: Riley Hospital for Children, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana.
authors: Konrad M
authors: KM
authors: Szymanski
authors: Riley Hospital for Children, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana.
authors: Rosalia
authors: R
authors: Misseri
authors: Riley Hospital for Children, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana.
authors: Benjamin
authors: B
authors: Whittam
authors: Riley Hospital for Children, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana.
authors: Sable
authors: S
authors: Amstutz
authors: Riley Hospital for Children, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana.
authors: Martin
authors: M
authors: Kaefer
authors: Riley Hospital for Children, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana.
authors: Richard C
authors: RC
authors: Rink
authors: Riley Hospital for Children, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana.
authors: Mark P
authors: MP
authors: Cain
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D001743:Urinary Bladder / Q000601:surgery*; D001744:Urinary Bladder Calculi / Q000453:epidemiology / Q000601:surgery*; D014547:Urinary Diversion; D013520:Urologic Surgical Procedures / Q000379:methods; D055815:Young Adult
keywords: lithotripsy; urinary bladder; urinary bladder calculi; urinary catheterization; urinary diversion