Bladder calculi in children who perform clean intermittent catheterization

Objective To examine the role of clean intermittent catheterization (CIC) a s a possible predisposing risk factor for bladder calculi, assessing risk f actors in patients with and without bladder augmentation, and to evaluate m anagement options for bladder calculi in these patients. Patients and methods The records of 403 patients who were using a regimen o f CIC between January 1981 and March 1998 were reviewed to identify those f orming bladder calculi; stones were diagnosed in 28 patients. The patients were categorized as: group 1, patients with no bladder augmentation who cat heterized urethrally (227, group 1a) or via a Mitrofanoff conduit (18, grou p 1b); group 2, patients with augmented bladders who catheterized urethrall y (100, group 2a) or via a Mitrofanoff conduit (58, group 2b). The incidenc e of bladder calculi in each group was determined and compared statisticall y where applicable. The success of the treatment options for stone manageme nt was reviewed. Results Bladder calculi developed in 5% of patients in group 1a, 8% in grou p 2a, 11% in group 1b, and 10% in group 2b; the incidence of calculi was no t significantly different among the groups. Of these patients, 18 (64%) wer e asymptomatic at the time of diagnosis and significant bacteriuria was fou nd in 23 (88%). Difficulty in catheterizing either the Mitrofanoff conduit or the native urethra was reported in 14 (50%) of these patients. Calculi w ere more often solitary (71%) and typically composed of struvite or apatite . Calculi were managed by open cystolithotomy in 15 patients (54%) and endo scopically in 13 (46%). Stones recurred in nine patients (32%) after treatm ent, comprising four of six patients treated endoscopically with electrohyd raulic lithotripsy and in five of 15 after open cystolithotomy. The mean in terval to recurrence was 22.8 months. Conclusion These results suggest that patients on a regimen of CIC are at r isk of developing bladder calculi but the incidence of calculi is not influ enced by bladder augmentation. The presence of a Mitrofanoff conduit was as sociated with a slightly increased incidence of calculus formation. Open cy stolithotomy was associated with a lower stone recurrence rate but there we re too few patients to draw definitive conclusions.