Kaefer M, Hendren W H, Bauer S B, Goldenblatt P, Peters C A, Atala A, Retik A B
Department of Surgery, Children's Hospital, Boston, Massachusetts, USA.
J Urol. 1998 Dec;160(6 Pt 1):2187-90.
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.
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.
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.
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.
肠道扩大膀胱形成尿路结石的倾向增加。诱发风险因素包括慢性菌尿、尿潴留和黏液分泌。胃储尿囊的黏液分泌可忽略不计，且有酸化尿液的能力。我们确定胃储尿囊形成结石的发生率是否也较低。
我们回顾性分析了1976年5月至1996年3月期间所有接受扩大膀胱成形术（215例）或独立储尿囊创建术（44例）患者的记录。其中83例采用胃扩大，179例采用其他肠段构建（即回肠、回盲部、乙状结肠和/或这些部位的组合）。记录患者的初始诊断、年龄、性别、其他外科手术、结石形成间隔时间和结石成分。随访时间不足1年的患者以及有肾或扩大膀胱术前结石的患者被排除在研究之外。
207例患者中有32例（15%）形成结石，平均间隔时间为3.6年（范围0.5至8.6年）。大多数结石由鸟粪石（磷酸镁铵）组成。包含胃段的储尿囊形成结石的可能性明显低于采用其他肠段扩大的储尿囊（70例中有2例，而137例中有30例，Fisher精确检验p<0.0001）。另外7例术前有膀胱结石且随后接受胃膀胱成形术的患者，平均随访3.0年，未再出现结石。
包含胃段的储尿囊很少形成结石。在胃扩大的患者中，结石似乎仅在患者接受组胺阻滞剂治疗或有形成仅在酸性环境中易形成的结石（如尿酸结石）倾向时才会出现。
