Cutting for stone in augmented bladders - What is the risk of recurrence and is it impacted by treatment modality?

Konrad Szymanski, Rosalia Misseri, Benjamin Whittam, Sable Amstutz, Martin Kaefer, Richard C. Rink, Mark P. Cain

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Purpose 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. Materials and 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.

Original languageEnglish
Pages (from-to)1375-1380
Number of pages6
JournalJournal of Urology
Volume191
Issue number5
DOIs
StatePublished - 2014

Fingerprint

Urinary Bladder
Urinary Bladder Calculi
Recurrence
Therapeutics
Ureter
Ileum
Kidney
Neurogenic Urinary Bladder
Cecum
Sigmoid Colon
Endoscopy
Stomach
X-Rays
Demography
Survival

Keywords

  • lithotripsy
  • urinary bladder
  • urinary bladder calculi
  • urinary catheterization
  • urinary diversion

ASJC Scopus subject areas

  • Urology

Cite this

Cutting for stone in augmented bladders - What is the risk of recurrence and is it impacted by treatment modality? / Szymanski, Konrad; Misseri, Rosalia; Whittam, Benjamin; Amstutz, Sable; Kaefer, Martin; Rink, Richard C.; Cain, Mark P.

In: Journal of Urology, Vol. 191, No. 5, 2014, p. 1375-1380.

Research output: Contribution to journalArticle

@article{93327748d73a454d95862955131c6131,
title = "Cutting for stone in augmented bladders - What is the risk of recurrence and is it impacted by treatment modality?",
abstract = "Purpose 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. Materials and 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.",
keywords = "lithotripsy, urinary bladder, urinary bladder calculi, urinary catheterization, urinary diversion",
author = "Konrad Szymanski and Rosalia Misseri and Benjamin Whittam and Sable Amstutz and Martin Kaefer and Rink, {Richard C.} and Cain, {Mark P.}",
year = "2014",
doi = "10.1016/j.juro.2013.11.057",
language = "English",
volume = "191",
pages = "1375--1380",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Cutting for stone in augmented bladders - What is the risk of recurrence and is it impacted by treatment modality?

AU - Szymanski, Konrad

AU - Misseri, Rosalia

AU - Whittam, Benjamin

AU - Amstutz, Sable

AU - Kaefer, Martin

AU - Rink, Richard C.

AU - Cain, Mark P.

PY - 2014

Y1 - 2014

N2 - Purpose 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. Materials and 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.

AB - Purpose 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. Materials and 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.

KW - lithotripsy

KW - urinary bladder

KW - urinary bladder calculi

KW - urinary catheterization

KW - urinary diversion

UR - http://www.scopus.com/inward/record.url?scp=84899086197&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84899086197&partnerID=8YFLogxK

U2 - 10.1016/j.juro.2013.11.057

DO - 10.1016/j.juro.2013.11.057

M3 - Article

VL - 191

SP - 1375

EP - 1380

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 5

ER -