Bladder augmentation is a surgery to increase bladder capacity and compliance. It involves transposition of a tissue segment, most commonly ileum (ileocystoplasty), into the native bladder. A narrowing can develop at the vesico-intestinal anastomosis resulting in an “hour-glass deformity”; this is a rare complication with few studies describing clinical implications and treatment.1 We present a case of a 35-year-old male with a history of bladder exstrophy and ileocystoplasty who presented with an hour-glass deformity with a large stone in both the augmented and native bladder. Following open cystolithotomy, he developed a vesico-cutaneous fistula requiring a complex repair.
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