Extracorporeal shock-wave lithotripsyin patients with spinal cord dysfunction

Niedrach, William L.; Davis, Robert S.; Tonetti, Frederick W.; Cockett, Abraham T.K.

doi:10.1016/s0090-4295(05)80077-9

Cited by 25 publications

(15 citation statements)

References 12 publications

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“…Of note, the study that reported a 95% incidence was specifically evaluating AD rate during SWL performed on SCI patients without anesthesia. 9,20 All other recorded outcomes were similar to rates reported in the general population including peri-nephric hemorrhage, post-op ileus and death.…”

Section: Discussionsupporting

confidence: 75%

“…This is significantly lower than reported clearance rates of 77-93% for URS in the non-SCI population. 2,4,5 In the SCI population, average clearance rates using SWL are 44-55%, [9][10][11] and percutaneous nephrolithotripsy clearance rates are 54-87%. 12,13 One possible explanation for the high failure rate of URS in the SCI population may be that chronic neurogenic bladder dysfunction can cause fibrosis and bladder wall contractures which alter the ureteral orifice and urethral anatomy.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

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

et al. 2012

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“…At least six case series describing SWL in a cohort of patients with SCI have been published (Level 4). [18][19][20][21][22][23] There are no more contemporary series than those in the late 1990s and all have relatively small numbers of patients (see Tables 1-3). No case control or comparative trial was identified.…”

Section: Presentation Of Stone Disease In Sci Patientsmentioning

confidence: 99%

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

Ramsey

McIlhenny

2011

Spinal Cord

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Objective: The objective is to review the published literature on the aetiology and evidence-based management of stone disease in the spinal cord-injured patient. Methods: A PubMed and Medline search was performed using the terms 'spinal cord injury', 'paraplegia', 'stone', 'nephrolithiasis', 'urolithiasis', 'calculus', 'spinal cord injury' or 'paraplegia' with 'SWL', 'ureteroscopy', 'chemolysis' and 'PCNL.' The Cochrane database, the National Institute for Clinical Excellence guidelines and the Scottish Intercollegiate guidelines were searched using the terms 'spinal cord injury' and 'urolithiasis' and 'nephrolithiasis'. Results: A total of 32 papers were identified, mainly case series or case-cohort studies with few contemporary papers. The risk of developing a renal stone after spinal cord injury (SCI) is between 7 and 20% over a period of 8-10 years. Stone formation may be related to early demineralisation of bone or chronic infection. Biochemical abnormalities are not significantly different between stone-forming and non-stone forming patients, though these patients differ from healthy controls. Presentation may be atypical, but is most commonly recurrent urinary tract infection. Treatment may be complicated by lower limb contractures limiting retrograde access. Several case series report success with shock wave lithotripsy varying from 50 to 70%, though comparisons are limited by heterogeneous indications and reporting. Percutaneous nephrolithotomy remains the gold standard for stones measuring 2 cm and above. Stone-free rates of 90% have been reported, though surgery was often complex with higher complication rates. Conclusion: Management of upper urinary tract stones in patients with SCI is complex regarding surgical technique, post-operative care and recurrence rates. Further contemporary case series must use standardised reporting tools to allow valid comparisons.Spinal Cord (2011) 49, 948-954;

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“…El tratamiento de la litiasis en los pacientes con MMC también presenta ciertas peculiaridades. La litotricia extracorpórea por ondas de choque (LEOC) es tolerada generalmente bien por los lesionados medulares, aunque la expulsión de los fragmentos litiásicos puede ser lenta 14 . En cualquier tipo de tratamiento, debe recordarse la frecuente alergia al látex en el MMC para tomar las medidas oportunas 15 .…”

Section: Discussionunclassified

Litiasis urinaria en adultos con mielomeningocele

Tartajo

Casado

Amo

et al. 2006

Actas Urológicas Españolas

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Introducción y objetivos: Los avances en el tratamiento de los nacidos con mielomeningocele (MMC) han logrado un gran aumento en su supervivencia, permitiéndoles una longevidad nunca antes alcanzada, pero todavía son escasos los datos concernientes a los problemas urológicos que estos enfermos plantean durante su vida adulta. Hemos evaluado las características de la litiasis urinaria en adultos nacidos con MMC así como los tratamientos empleados en la misma. Material y métodos: Revisamos 52 pacientes nacidos con MMC de entre 18 y 40 años, atendidos durante los últimos 14 años en nuestro hospital, con una media de seguimiento de 6,7 años. Resultados: Se diagnosticaron de litiasis urinaria 10 pacientes (19,2%). Tres formaron cálculos renales (5,7%), y uno de ellos, junto con 7 pacientes más, desarrollaron cálculos vesicales (15,3%). El nivel neurológico fue ≤ L 2 en 3 casos, L 2-S 1 en 5, y ≥ S 1 en otros dos. El tipo de disfunción neurógena del tracto urinario inferior fue de lesión múltiple pura de neurona motora inferior en 6 casos, de neurona motora superior en 1, lesión múltiple mixta en otro, no pudiéndose valo-rar en el restante. Dos pacientes tenían una ampliación vesical y uno de estos junto con otros 3 pacientes era portador de AMS-800 no funcionantes. La litiasis vesical se trató endoscopicamente en 14 ocasiones y mediante cistolitotomía suprapúbica en 4, junto a la retirada de AMS-800 en 3 de ellas. Un paciente expulsó un pequeño cálculo. En un pacien-te fueron necesarias 2 litotricias extracorpóreas y 2 nefrolitotomías percutáneas. Tres pacientes tuvieron múltiples reci-divas. Conclusiones: La litiasis urinaria es frecuente en los adultos con MMC. Determinadas características de estos pacien-tes, junto con su configuración anatómica y algunos tratamientos empleados en ellos, ocasionan problemas de diagnos-tico, tratamiento y prevención de los cálculos que forman. ABSTRACT URINARY CALCULI IN MYELOMENINGOCELE ADULTS Introduction and objectives: the improvements in the management of newborns with myelomeningocele (MMC) have obtained a big increase in survival, allowing them to get longevity like never before, but data regarding urologic diseases during adult age are still missing. We herein evaluate the features of urinary lithiasis in adults born with MMC and the therapies used for its treatment. Material and method: we review 52 patients diagnosed at birth of MMC, between 18 and 40 years old, treated in our institution, with a mean follow-up of 6.7 years. Results: 10 patients (19.2%) were diagnosed of urolithiasis. Three developed kidney calculi and one of them, with 7 more patients, developed bladder calculi (15.3%). The neurological level was ≤ L2 in 3 cases, L2-S1 in 5, and ≥ S1 in the other two. The type of neurogenic dysfunction of inferior urinary tract was multiple lesion of lower motor neurone in 6 cases, upper motor neurone in 1 case, multiple mixed lesion in 1 case and in case it was impossible to determine. Two patients had a bladder augmentation procedure and one of these with other 3 patie...

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Extracorporeal shock-wave lithotripsyin patients with spinal cord dysfunction

Cited by 25 publications

References 12 publications

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

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

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

Litiasis urinaria en adultos con mielomeningocele

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