title: Treatment of pouch stones after augmentation ileocystoplasty in children: is it always bothersome?
abstract: OBJECTIVE
  To report our experience with different approaches for management of pouch stones in children with ileal-based urinary reservoir.
  
  
  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).
  
  
  CONCLUSIONS
  Pouch stones are established long-term complication of urinary diversion. Open and endoscopic approaches are valid treatment strategies.
authors.affiliation: Department of Pediatric Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. Electronic address: drthelmy@yahoo.com.
authors.forename: Tamer E
authors.initials: TE
authors.lastname: Helmy
authors.affiliation: Department of Pediatric Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Mohammed M
authors.initials: MM
authors.lastname: Elawdy
authors.affiliation: Department of Pediatric Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: AbdelHalim
authors.affiliation: Department of Pediatric Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Hesham
authors.initials: H
authors.lastname: Orban
authors.affiliation: Department of Pediatric Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Hossam
authors.initials: H
authors.lastname: Nabeeh
authors.affiliation: Department of Pediatric Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Dawaba
authors.affiliation: Department of Pediatric Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Ashraf T
authors.initials: AT
authors.lastname: Hafez
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000628:therapy*; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000601:surgery*; D014545:Urinary Calculi / Q000628:therapy*; D016476:Urinary Reservoirs, Continent