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Bladder Stones in a continent urinary diversion

D Gillatt

A 49-year-old female was diagnosed with bladder cancer 3 years ago. After a radical cystectomy and Mitroffanof she had no further significant urological problems. There was no leakage and no urinary tract infections.


Six months later an IVU showed that her kidneys were draining well into the new pouch. She was catheterising every 4 hours, sleeping through the night and there was no clinical evidence of recurrence of the cancer.


Following another check up 3 months later however, she was found to have 4 asymptomatic stones in the Mitranoff.

A percutaneous operation removed these stones successfully and the patient made a complete recovery. Her urine output was excellent and the content of the urine was also normal. Plain x-ray showed no evidence of any residual stones, and analysis of the extracted stones revealed that they were composed of calcium phosphate. She was discharged with advice to maintain a high fluid intake.


Four months later she returned to clinic after passing a few stone fragments. An x-ray showed that she had developed some more stones in her bladder. These were washed out via her small stoma.

It appears that this patient is hyper-calcaeuric and treatment could take the form of regular full bladder washouts to reduce the incidence of stones forming. At this point she was also referred to a consultant renal physician for advice on other measures for preventing further stone formation.

Consultant renal physician's comments:

Phosphate stones are less common than oxalate stones and are more usually seen in patients with renal tubular acidosis. This is probably because decreased citrate excretion is found in systemic acidosis and is an important risk factor for stone formation.

Her repeat citrate excretion was very low and, therefore, the rational treatment would be to give her citrate supplements in the hope that this would prevent further stone formation.

The aim is to increase her citrate level to the top of the normal range. This, together with a continued high fluid intake plus continued attention to complete bladder emptying, should significantly reduce the risk of new stone formation.

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