Management of bladder calculi after continent diversion

Objectives: The objectives of the study were to characterize the safety, efficacy, and recurrence rates of bladder calculi treatment in a cohort of adult patients with a history of continent lower urinary tract reconstruction. Patients and Methods: We conducted a retrospective review of adult patients with prior continent lower urinary tract reconstruction utilizing bowel who underwent surgical treatment for bladder calculi at our institution. Surgical approach was classified as endoscopic (i.e., per urethra or per catheterizable channel), percutaneous, or open. The primary outcome of interest was bladder stone recurrence, defined as any unplanned additional surgery for bladder stones. Results: We identified 64 patients who underwent 95 bladder stone surgeries. 69/95 cases (73%) involved a bladder augment and catheterizable channel, 11/95 (12%) a bladder augment only, and 11/95 (12%) a catheterizable channel only. 56/95 cases (59%) were endoscopic, 34/95 (36%) percutaneous, and 5/95 (5%) open. Over a median follow-up of 46 months (interquartile range 25–73), the overall recurrence rate was 43/95 (45%); this did not differ when stratifying by surgery type ( P = 0.52). Median time to reoperation was 25 months (15–38) and did not differ by surgery type ( P = 0.29). Conclusion: In our series, patients with bladder calculi after continent diversion could be treated surgically with minimal associated morbidity. Endoscopic and percutaneous techniques can manage the majority of calculi, with open cystolithotomy reserved for exorbitant stone burden. Recurrence rates and time to recurrence do not appear to differ by treatment modality.