Reservoir calculi: A comparison of reservoirs constructed from stomach and other enteric segments

被引:76
作者
Kaefer, M
Hendren, WH
Bauer, SB
Goldenblatt, P
Peters, CA
Atala, A
Retik, AB
机构
[1] Childrens Hosp, Dept Surg, Boston, MA 02115 USA
[2] Childrens Hosp, Dept Urol, Boston, MA 02115 USA
关键词
bladder; urinary diversion; calculi; stomach;
D O I
10.1016/S0022-5347(01)62290-0
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose: The intestinal augmented bladder has an increased propensity to form urinary calculi. Predisposing risk factors include chronic bacteriuria, urinary stasis and mucus production. Gastric reservoirs have negligible mucus production and the ability to acidify the urine. We determined whether they also have a decreased incidence of stones. Materials and Methods: We retrospectively reviewed the records of all patients undergoing augmentation cyptoplasty (215) or creation of a freestanding reservoir (44) between May 1976 and March 1996. Of these cases 83 were augmented with stomach and 179 were constructed from other intestinal segments, (that is ileal, ileocecal, sigmoid and/or a combination of these). Presenting diagnosis, patient age, gender, additional surgical procedures, interval to stone formation and calculous composition were recorded. Patients were excluded from study when there was less than 1 year of followup, as were those with renal or pre-augmentation bladder calculi. Results: Stones formed in 32 of 207 patients (15%) after an average interval of 3.6 years (range 0.5 to 8.6). The majority of stones were composed of struvite (magnesium ammonium phosphate). Reservoirs containing gastric segments were significantly less likely to form calculi than those augmented with other intestinal segments (2 of 70 versus 30 of 137, p<0.0001 Fisher's exact test). Seven additional patients with pre-augmentation bladder stones who subsequently underwent gastrocystoplasty remain stone-free at an average followup of 3.0 years. Conclusions: Calculous formation is rare in reservoirs that incorporate a gastric segment. In patients with gastric augmentation stones appear only to develop when the patient is on histamine blockade or has a propensity to form stones that only favor an acidic environment, such as uric acid.
引用
收藏
页码:2187 / 2190
页数:4
相关论文
共 21 条
[1]   GASTROCYSTOPLASTY - AN ALTERNATIVE SOLUTION TO THE PROBLEM OF UROLOGICAL RECONSTRUCTION IN THE SEVERELY COMPROMISED PATIENT [J].
ADAMS, MC ;
MITCHELL, ME ;
RINK, RC .
JOURNAL OF UROLOGY, 1988, 140 (05) :1152-1156
[2]   THE EFFECT OF GASTRIC AUGMENTATION ON BLADDER FUNCTION [J].
ATALA, A ;
BAUER, SB ;
HENDREN, WH ;
RETIK, AB .
JOURNAL OF UROLOGY, 1993, 149 (05) :1099-1102
[3]   LITHOGENIC PROPERTIES OF ENTEROCYSTOPLASTY [J].
BLYTH, B ;
EWALT, DH ;
DUCKETT, JW ;
SNYDER, HM .
JOURNAL OF UROLOGY, 1992, 148 (02) :575-577
[4]   TREATMENT OF BLADDER DYSFUNCTION IN CHILDREN WITH END-STAGE RENAL-DISEASE [J].
BURNS, MW ;
WATKINS, SL ;
MITCHELL, ME ;
TAPPER, D .
JOURNAL OF PEDIATRIC SURGERY, 1992, 27 (02) :170-174
[5]   URETERAL BLADDER AUGMENTATION [J].
CHURCHILL, BM ;
ALIABADI, H ;
LANDAU, EH ;
MCLORIE, GA ;
STECKLER, RE ;
MCKENNA, PH ;
KHOURY, AE .
JOURNAL OF UROLOGY, 1993, 150 (02) :716-720
[6]   URIC-ACID STONE AND GASTRIC BLADDER AUGMENTATION [J].
GARZOTTO, MG ;
WALKER, RD .
JOURNAL OF UROLOGY, 1995, 153 (06) :1976-1976
[7]   BLADDER EXSTROPHY - INCREASE IN CAPACITY FOLLOWING EPISPADIAS REPAIR [J].
GEARHART, JP ;
JEFFS, RD .
JOURNAL OF UROLOGY, 1989, 142 (02) :525-526
[8]   BLADDER AUGMENTATION - EXPERIENCE WITH 129 CHILDREN AND YOUNG-ADULTS [J].
HENDREN, WH ;
HENDREN, RB .
JOURNAL OF UROLOGY, 1990, 144 (02) :445-453
[9]  
HOLLENSBE D W, 1992, Journal of Urology, V147, p253A
[10]   Continent urinary diversion: The Children's Hospital experience [J].
Kaefer, M ;
Tobin, MS ;
Hendren, WH ;
Bauer, SB ;
Peters, CA ;
Atala, A ;
Colodny, AH ;
Mandell, J ;
Retik, AB .
JOURNAL OF UROLOGY, 1997, 157 (04) :1394-1399