Bladder stone as a complication of AUS insertion and bladder augmentation: Report of two cases

Abstract

Introduction and objectives: Urinary incontinence is a major concern that directly effects quality of life in patients with neurogenic bladder due to myelomeningocele (MMC). These patients often benefit from operations such as bladder augmentation, or insertion of an artificial urinary sphincter (AUS). The management often begins during adolescence but usually needs long-term surveillance and further interventions to preserve the function or continence in these patients. Methods: We report two interesting cases of complications in patients with history of AUS and bladder augmentation performed for control of urinary incontinence on the back ground of spina bifida. Results: Case 1: 15-year-old boy with MMC involving lower lumbar segments with neurogenic bladder and bowel dysfunction. He underwent bladder augmentation and AUS insertion, with good results in terms of control of urinary incontinence. On follow up, 9 months after the procedure it was noticed that the tubing of the AUS has eroded through the skin. He underwent a cystoscopy which confirmed erosion of the device into the bladder and formation of a large bladder stone around the reservoir. An open cystolithotomy was performed and AUS device was removed. He recovered well after this procedure, and is awaiting re-insertion of AUS. Case 2: 33-year-old gentleman with previous history of bladder augmentation and AUS in adolescence on background of MMC presented to emergency department with urosepsis. He was managed conservatively with intravenous antibiotics. CT scan showed a large 16 cm bladder stone. Decision was made to perform elective open cystolithotomy to remove the bladder stone. Conclusions: Bladder augmentation and implantation of AUS are common amongst the patients with neurogenic bladder. Close monitoring and follow up of these patients is very important to treat any possible complications such as infection or formation of bladder stones.L6213521242018-03-27 <br />