Szymanski Konrad M, Misseri Rosalia, Whittam Benjamin, Amstutz Sable, Kaefer Martin, Rink Richard C, Cain Mark P
Riley Hospital for Children, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana.
J Urol. 2014 May;191(5):1375-80. doi: 10.1016/j.juro.2013.11.057. Epub 2013 Dec 5.
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.
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.
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.
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.
膀胱扩大术后膀胱结石很常见，常导致多次复发手术。我们试图确定手术技术和结石破碎是否是膀胱扩大术后膀胱结石复发的重要预测因素。
我们回顾性分析了我院107例首次治疗膀胱结石的患者。回顾了患者的人口统计学资料、手术细节、结石治疗及复发情况。采用Kaplan-Meier生存分析和Cox比例风险分析来确定首次结石复发时间的预测因素。
107例患者中，55.1%为女性，79.4%患有神经源性膀胱。患者接受膀胱扩大术的中位年龄为8.0岁（范围2.4至22.8岁），中位随访时间为12.4年（1.8至34年）。用于膀胱扩大的肠段包括回肠（72.9%的病例）、乙状结肠（16.8%）、盲肠/回盲部（9.4%）和其他（输尿管、胃/回肠，1.8%）。63.6%的患者进行了膀胱颈手术，75.7%的患者有可导尿通道。首次结石手术发生在膀胱扩大术后的中位时间为3.1年（范围5个月至21.8年）。66.4%的病例采用了内镜治疗，33.6%采用了开放性膀胱切开取石术。总体而言，47.7%的结石被破碎。47.7%的患者膀胱结石复发（中位复发时间9.5年，范围3个月至14.7年）。术后前2年复发风险最高（每位患者每年12.1%，p = 0.03）。即使在控制了手术和临床变量后，复发风险也不会因技术（内镜与开放）或结石破碎而改变。
术后9年近一半患者膀胱结石复发，与治疗技术和患者特征无关。作为高危人群，建议对这些患者每年进行肾脏、输尿管和膀胱X线检查以及肾脏和膀胱超声检查。
