S1856 Risk Factors and Outcomes of Urolithiasis Amongst Veterans With Inflammatory Bowel Disease

Introduction: Inflammatory Bowel Disease (IBD), particularly Crohn’s Disease (CD), has been associated with an increased risk of urolithiasis in some studies. However, other risk factors for urinary tract stone formation in IBD patients remain unknown. This study aims to evaluate the characteristics and outcomes of IBD patients with urolithiasis and identify potential risk factors for urolithiasis in IBD. Methods: We conducted a retrospective study of IBD patients followed at the Jerry L. Pettis Memorial Veterans' IBD clinic from January to June 2024. Patient charts were reviewed dating back to 1999. Data collected included patient demographics, IBD type, Charles Comorbidity Index (CCI), abdominal surgery, IBD medications, development of urolithiasis, and outcomes. Major abdominal surgery included small bowel or colon resection or ileal pouch anal anastomosis. Minor surgery included stricturoplasty, incision and drainage, or seton placement. Other surgery included cholecystectomy and appendectomy. Descriptive analysis was used. Results: Among 328 patients with IBD (8.8% women), 186 (56.7%) had Ulcerative Colitis (UC), 120 (36.6%) had CD, and 22 (6.7%) had Indeterminate Colitis. 41 patients (12.5%) developed urolithiasis, with 33 (80.5%) experiencing nephrolithiasis. Patients with urolithiasis were older (67.1 ± 14.7 years vs 61.1 ± 16.3 years; P = 0.031), had higher CCI (4.6 ± 3.0 vs 3.0 ± 2.7; P < 0.001), and were more likely to have had major abdominal surgery (46.3% vs 16.4%; P < 0.001). 46.3% of these patients had CD, whereas 35.2% of patients without urolithiasis had CD (P = 0.017). Among the 41 patients with urolithiasis, 23 (56.1%) were symptomatic, and 12 (29.3%) required urologic intervention. Four patients underwent shock wave lithotripsy, 7 underwent ureteroscopy, 6 underwent laser lithotripsy, and 1 underwent percutaneous nephrolithotomy. No patients required laparoscopic or open surgery. One UC patient, on adalimumab, developed a post-procedural urinary tract infection within 90 days. Another CD patient discontinued vedolizumab prior to undergoing ureteroscopy and laser lithotripsy to minimize the risk of infection. Conclusion: IBD patients, particularly those with CD, older age, higher comorbidity, and history of major abdominal surgery, face a higher risk of urolithiasis. Overall, urolithiasis management in IBD appears safe, with minimal complications.