Evidence-based management of upper tract urolithiasis in the spinal cord-injured patient

Ramsey, S.; McIlhenny, C

doi:10.1038/sc.2011.50

Cited by 34 publications

(22 citation statements)

References 31 publications

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“…8 The morbidity associated with PNLs among SCI patients is significant, with major complication, (such as abscess, pneumothorax, sepsis, fistula, respiratory arrest and death) occurring in 6-20% of patients. 4 This is consistent with our results, which demonstrated that 12% of SCI patients required ICU consultation after stone treatment.…”

Section: Discussionsupporting

confidence: 83%

“…4 Complications were rare, and generally related to sepsis or intraoperative cardiovascular changes. Similarly, our cohort tolerated SWL well, with patients rarely requiring hospital admission or ICU consultation, and typically requiring a median of two procedures.…”

Section: Discussionmentioning

confidence: 99%

“…3 Upper tract stone disease among SCI patients has significant complications because of an atypical clinical presentation, obstructive urosepsis and treatment-related complications. 4 Percutaneous nephrolithotomy (PNL) maybe more common among SCI patients, and has been reported to be associated with significant perioperative morbidity and mortality. [5][6][7] The use of ureteroscopy was traditionally limited by the inability to position many SCI patients in the lithotomy position; however, the contemporary use of flexible ureteroscopy in this population has not been formally studied.…”

Section: Introductionmentioning

confidence: 99%

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The surgical management of upper tract stone disease among spinal cord-injured patients

et al. 2013

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The surgical management of upper tract stone disease among spinal cord-injured patients

et al. 2013

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“…14 In addition, patients with SCI often suffer from lower extremity contractures making positioning in the lithotomy position difficult or impossible. 15 In our current series, nearly half (45.5%) of failures were due to technical limitations (inability to access the ureteral orifice or inability to access stones), making this an important factor for patient counseling. Interestingly, pre-procedure placement of a ureteral stent did not prevent technical failures.…”

Section: Discussionmentioning

confidence: 99%

Ureteroscopy with laser lithotripsy for urolithiasis in the spinal cord injury population

et al. 2012

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Study design: Retrospective study. Objectives: The purpose of this investigation was to review the outcomes and safety of retrograde ureteroscopic laser lithotripsy (URS) for the treatment of urolithiasis in the spinal cord injury (SCI) population. Setting: Virginia, USA. Methods: All patients with SCI who underwent URS with holmium:YAG laser lithotripsy for urolithiasis over a 15-year period were identified. Stone size, location and number at presentation were recorded. Information regarding patient characteristics, intra-operative complications, surgical efficacy, stone clearance, peri-operative complications, and follow-up stone events was collected and analyzed. Results: A total of 67 URS procedures were performed on 29 SCI patients during the study period with an average follow-up of 3.4 years. Patients had an average of 2.3 ipsilateral ureteroscopies. The majority (85.1%) used indwelling catheters for long-term bladder management, and complete stone clearance after the first procedure was 34.3%. Of the 44 cases with residual stones 44 mm, 20 (45.5%) were secondary to technical or procedural limitations. The intra-operative complication rate was comparable to non-SCI studies at 1.5%, but peri-operative complications were significantly higher at 29.9% with the majority due to urosepsis. Factors associated with peri-operative complications include chronic obstructive pulmonary disease, motor incomplete injuries and lack of a pre-operative ureteral stent. Conclusion: URS in the SCI population is an effective treatment for ureteral or renal stones but may be associated with greater risks and reduced efficacy. With advances in endourology, ureteroscopic surgery has become a popular choice for the minimally invasive treatment of urolithiasis. In the general population, studies reveal stone-free rates between 77 and 93% after one procedure. Success varies depending on size, number and location of stones. 2-5 Intra-operative complications range between 0 and 6%, and major peri-operative complications between 1 and 3%. 2,4,6 Unfortunately, it is not known whether these studies are directly applicable to patients with SCI. SCI results in neurogenic bladder, which significantly alters bladder function including ability to empty, bladder pressure, continence and bladder compliance. 7 Detrusor-sphincter-dyssynergia, a common problem in SCI patients with neurogenic bladder dysfunction, can cause elevated detrusor

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“…The incidence of upper tract stones in UD is between 11 and 20% [7][8][9]. The 5-year recurrence rate for patients with history of urolithiasis is 63% [2,10].…”

Section: Introductionmentioning

confidence: 99%

Challenges of Retrograde Ureteroscopy in Patients with Urinary Diversion: Outcomes and Lessons Learnt from a Systematic Review of Literature

Ramachandra¹,

Somani²

2018

Urol Int

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Introduction:Retrograde ureteroscopy (URS) can be safely and successfully performed in patients who have had previous urinary diversion (UD). With broadening indications and advances in technology, URS can be used in complex cases. In this review article, we have summarized the relevant published literature regarding the outcomes and challenges encountered during retrograde URS in patients with UD. Materials and Methods: We conducted a systematic review of literature according to Cochrane and preferred reporting items for systematic reviews and meta-analysis guidelines for all studies reporting on retrograde URS from inception to September 2017. A literature search was conducted through MEDLINE, EMBASE, CINAHL, and Cochrane library for all English language articles. Results: Our literature search identified 6 retrospective studies. In total, 125 patients with a mean age of 67 years (range 28-90 years) underwent retrograde URS (190 procedures) after UD for diagnostic and therapeutic purposes. The main indications included upper urinary tract filling defects (due to either intrinsic pathology or extrinsic compression), strictures due to ureteral thickening, stone disease, and surveillance for suspected malignancy. The success rate and complications across the studies varied from 56 to 80% and 0 to 44% respectively, with most complications being Clavien I in nature. Conclusion: Retrograde URS can be technically challenging due to ureteric cannulation, strictures, and anatomical variations. However, there is very little evidence currently available on this topic with data based on retrospective case series. In experienced hands, it seems to be relatively successful with a low risk of major complications.

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Evidence-based management of upper tract urolithiasis in the spinal cord-injured patient

Cited by 34 publications

References 31 publications

The surgical management of upper tract stone disease among spinal cord-injured patients

The surgical management of upper tract stone disease among spinal cord-injured patients

Ureteroscopy with laser lithotripsy for urolithiasis in the spinal cord injury population

Challenges of Retrograde Ureteroscopy in Patients with Urinary Diversion: Outcomes and Lessons Learnt from a Systematic Review of Literature

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