Can regular Bladder washouts and Acetylcysteine instillation prevent stone formation and reduce the Incidence of Urine Infections in the Augmented Bladder?

PurposeTo monitor the effects of a regular bladder washout regime and the use of acetylcysteine in the prevention of stones and frequency of symptomatic urine infections in children post bladder augmentation.Material and Methods19 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 an 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.ResultsFrequency of bladder washouts varied considerably from once daily up to 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. Washout dwell time was less than 5 mins in 17 and 5-10 mins in 2. 7 children used acetylcysteine in the 1st six weeks postoperatively. 13 children were taking prophylactic antibiotics. The incidence of bladder stone formation to date is zero. The incidence of symptomtic urine infection was less than 1 episode in a 6 month period in these children.ConclusionsAdhering 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 for the provision of such excellent standards of clinical care and outcomes and also in achieving good compliance from the children after major bladder reconstruction.