Can Regular Bladder Washouts and Acetylcysteine Instillation Prevent Stone Formation and Reduce Incidence of Urine Infections in the Augmented Bladder
Abstract Purpose To monitor the effects of regular bladder washout regime and use of acetylcysteine in te prevention of stones and frequency of symptomatic urine infections in children post bladder augmentation. Material and Methods 19 children, 8 boys and 11 girls (mean age 13.54 years) who underwent augmentation cystoplasty with a mean followup of 37 months (11-98)were included. All of them were contacted with questionnaires. Information requested included frequency of bladder washouts both in the first three months after surgery and presently to date, type of solution used and whether acetylcysteine solution was prescribed ay any time for the management of severe mucous production. The clinical nurse specialists in our department have extended outdoor role with liaison in the community. The children and families are contacted regularly to ensure compliance and providing support to them as needed. Results Frequency of bladder washouts varied considerably from once daily upto four times a day in the first 3 months. Following that the ferquency reduced significantly to once daily to not at all. All chldren used saline for the washouts. Wsahout dwell time was less tha 5 mins in 17 ans 5-10 mins in 2. 7 children used acetylcysteine in the 1st six weeks postoperatively. 13 children were taking prohylactic antibiotics. The incidence of bladder stones formation to date is zero. Incidence of symptomtic urine infection was less than 1 episode in a 6 month period in these children. Conclusions Adhering strictly to postoperative bladder washout regimes indicates that NO children in this study have any evidence of bladder stone formation and the incidence of symptomatic urine infections was significantly reduced. The services of a clinical nurse specialist with outdoor liaison duties is invaluable to provision of such excellent standards of clinical care and outcomes and also in achieving good compliance from the children after major bladder reconstruction.