Barroso U, Jednak R, Fleming P, Barthold J S, González R
Department of Paediatric Urology, Children's Hospital of Michigan and Wayne State University School of Medicine, Detroit, Michigan, USA.
BJU Int. 2000 May;85(7):879-84. doi: 10.1046/j.1464-410x.2000.00625.x.
To examine the role of clean intermittent catheterization (CIC) as a possible predisposing risk factor for bladder calculi, assessing risk factors in patients with and without bladder augmentation, and to evaluate management options for bladder calculi in these patients.
The records of 403 patients who were using a regimen of CIC between January 1981 and March 1998 were reviewed to identify those forming bladder calculi; stones were diagnosed in 28 patients. The patients were categorized as: group 1, patients with no bladder augmentation who catheterized urethrally (227, group 1a) or via a Mitrofanoff conduit (18, group 1b); group 2, patients with augmented bladders who catheterized urethrally (100, group 2a) or via a Mitrofanoff conduit (58, group 2b). The incidence of bladder calculi in each group was determined and compared statistically where applicable. The success of the treatment options for stone management was reviewed.
Bladder calculi developed in 5% of patients in group 1a, 8% in group 2a, 11% in group 1b, and 10% in group 2b; the incidence of calculi was not significantly different among the groups. Of these patients, 18 (64%) were asymptomatic at the time of diagnosis and significant bacteriuria was found in 23 (88%). Difficulty in catheterizing either the Mitrofanoff conduit or the native urethra was reported in 14 (50%) of these patients. Calculi were more often solitary (71%) and typically composed of struvite or apatite. Calculi were managed by open cystolithotomy in 15 patients (54%) and endoscopically in 13 (46%). Stones recurred in nine patients (32%) after treatment, comprising four of six patients treated endoscopically with electrohydraulic lithotripsy and in five of 15 after open cystolithotomy. The mean interval to recurrence was 22.8 months.
These results suggest that patients on a regimen of CIC are at risk of developing bladder calculi but the incidence of calculi is not influenced by bladder augmentation. The presence of a Mitrofanoff conduit was associated with a slightly increased incidence of calculus formation. Open cystolithotomy was associated with a lower stone recurrence rate but there were too few patients to draw definitive conclusions.
探讨清洁间歇性导尿（CIC）作为膀胱结石潜在危险因素的作用，评估有无膀胱扩大术患者的危险因素，并评估这些患者膀胱结石的治疗选择。
回顾1981年1月至1998年3月期间采用CIC方案的403例患者的记录，以确定形成膀胱结石的患者；28例患者被诊断为结石。患者分为：第1组，未行膀胱扩大术的患者，经尿道导尿（227例，1a组）或经米氏通道导尿（18例，1b组）；第2组，行膀胱扩大术的患者，经尿道导尿（100例，2a组）或经米氏通道导尿（58例，2b组）。确定每组膀胱结石的发生率，并在适用时进行统计学比较。回顾结石治疗方案的成功率。
1a组5%的患者发生膀胱结石，2a组为8%，1b组为11%，2b组为10%；各组结石发生率无显著差异。在这些患者中，18例（64%）在诊断时无症状，23例（88%）发现有显著菌尿。14例（50%）患者报告经米氏通道或天然尿道导尿困难。结石多为单发（71%），通常由鸟粪石或磷灰石组成。15例（54%）患者采用开放性膀胱切开取石术治疗，13例（46%）采用内镜治疗。9例（32%）患者治疗后结石复发，其中6例接受内镜电液压碎石术治疗的患者中有4例复发，15例接受开放性膀胱切开取石术治疗的患者中有5例复发。复发的平均间隔时间为22.8个月。
这些结果表明，采用CIC方案的患者有发生膀胱结石的风险，但结石发生率不受膀胱扩大术的影响。米氏通道的存在与结石形成发生率略有增加有关。开放性膀胱切开取石术与较低的结石复发率相关，但患者数量过少，无法得出明确结论。
