Percutaneous nephrolithotomy in patients with spinal cord injury: should all these patients be automatically assigned a Guy’s stone score of 4?

Torricelli, Fábio César Miranda; Vicentini, Fábio Carvalho; Zanetti, Lucas Arantes; Perrella, Rodrigo; Marchini, Giovanni Scala; Danilovic, Alexandre; Batagello, Carlos; Murta, Cláudio Bovolenta; Claro, Joaquim F.A.; Srougi, Miguel; Nahas, William C.; Mazzucchi, Eduardo

doi:10.1007/s00345-020-03443-1

Cited by 7 publications

(10 citation statements)

References 19 publications

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“…Surgical treatment of lumbar intervertebral disc herniation with the social development and scientific and technological progress has experienced from traditional to minimally invasive changes, and laminofenestration lumbar intervertebral disc resection is one of the classic traditional surgical treatments of LDH. Its clinical effect is satisfactory, but it causes lumbar rear muscle and bone structure damage, prone to lumbar instability and residual back pain [ 23 ]. At the same period, the technology was introduced into China, which favorably laid the foundation for the development of minimally invasive spine surgery technology in China.…”

Section: Discussionmentioning

confidence: 99%

Clinical Efficacy and Safety of Percutaneous Spinal Endoscopy versus Traditional Open Surgery for Lumbar Disc Herniation: Systematic Review and Meta-Analysis

Chen

Tang

et al. 2022

Journal of Healthcare Engineering

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Objective. Systematic analysis of the incidence of percutaneous spinal endoscopic technique and traditional open surgery for lumbar disc herniation. Methods. A randomized controlled trial (RCT) and cohort study on complications related to traditional open surgery was searched on the MEDLINE, Cochrane Library, PubMed, Web of Science, Chinese journal full-text database (CNKI), Wanfang, and Embase database. Language is not limited. The quality of each study was evaluated, various complications were compiled into electronic baseline tables, and the data from these studies were available. Meta-analysis and synthesis were performed with the RevMan 5.3 software to evaluate the statistical significance of both surgical techniques in terms of various complications. Results. 12 studies were eventually included, and a total of 2,797 patients were included in the analysis. Meta-analysis results showed that there was no statistical difference in postoperative paresthesia between percutaneous spinal endoscopy and traditional open surgery (OR = 1.17, 95% CI (0.82, 1.66), P = 0.38, I2 = 0%, Z = 0.88), direct nerve root damage (OR = 0.79, 95% CI (0.58, 1.07), P = 0.13, I2 = 73%, Z = 1.52), and intraoperative hemorrhage and hematoma formation (OR = 1.00, 95% CI (0.67, 1.48), P = 0.99, I2 = 0%, Z = 0.02), but there was a statistical difference in disc recurrence (OR = 2.24, 95% CI (1.56, 3.21), P < 0.0001, I2 = 81%, Z = 4.39). Conclusion. Compared with the traditional open surgical treatment of lumbar disc herniation, percutaneous spinal endoscopic technology has obvious advantages in reducing nerve root injury, dural injury, and surgical area wound complications, but it is limited to preventing the technical characteristics of the surgical site, which is worse than that of open surgery.

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Section: Discussionmentioning

confidence: 99%

Clinical Efficacy and Safety of Percutaneous Spinal Endoscopy versus Traditional Open Surgery for Lumbar Disc Herniation: Systematic Review and Meta-Analysis

Chen

Tang

et al. 2022

Journal of Healthcare Engineering

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“…We found was no statistical difference on the percentage rate of patients with SCI between groups and none of them received a blood transfusion. In fact, a recent study by our group emphasises that SCI should not be automatically assigned GSS IV [51].…”

Section: Discussionmentioning

confidence: 99%

Tranexamic acid in patients with complex stones undergoing percutaneous nephrolithotomy: a randomised, double‐blinded, placebo‐controlled trial

et al. 2021

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To assess the efficacy and safety of single-dose tranexamic acid on the blood transfusion rate and outcomes of patients with complex kidney stones undergoing percutaneous nephrolithotomy (PCNL). Patients and MethodsIn a randomised, double-blinded, placebo-controlled trial, 192 patients with complex kidney stone (Guy's Stone Scores III-IV) were prospectively enrolled and randomised (1:1 ratio) to receive either one dose of tranexamic acid (1 g) or a placebo at the time of anaesthetic induction for PCNL. The primary outcome measure was the occurrence rate of perioperative blood transfusion. The secondary outcome measures included blood loss, operative time, stone-free rate (SFR), and complications. ClinicalTrials.gov identifier: NCT02966236. ResultsThe overall risk of receiving a blood transfusion was reduced in the tranexamic acid group (2.2% vs 10.4%; relative risk, 0.21, 95% confidence interval [CI] 0.03-0.76, P = 0.033; number-needed-to-treat: 12). Patients randomised to the tranexamic acid group had a higher immediate and 3-month SFR compared with those in the placebo group (29% vs 14.7%, odds ratio [OR] 2.37, 95% CI 1.15-4.87, P = 0.019, and 46.2% vs 28.1%, OR 2.20, 95% CI 1.20-4.02, P = 0.011, respectively). Faster haemoglobin recovery occurred in patients in the tranexamic acid group (mean, 21.3 days; P = 0.001). No statistical differences were found in operative time and complications between groups. ConclusionsTranexamic acid administration is safe and reduces the need for blood transfusion by five-times in patients with complex kidney stones undergoing PCNL. Moreover, tranexamic acid may contribute to better stone clearance rate and faster haemoglobin recovery without increasing complications. A single dose of tranexamic acid at the time of anaesthetic induction could be considered standard clinical practice for patients with complex kidney stones undergoing PCNL.

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“…Three studies compared SFR following PCNL in SCI patients to non-SCI patients [14,28,35]. Meta-analysis found that there were no signi cant differences between groups in post-PCNL SFR (OR 0.64; 95% CI, 0.15-2.64; I 2 = 77%, p = 0.01) (Fig.…”

Section: Kidney Stone Characteristicsmentioning

confidence: 99%

“…23 studies reported the rate of complications following surgical therapy for nephrolithiasis (Supplemental Table S2) [10,11,[13][14][15][16][17][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Meta-analysis was performed on four studies reporting post-PCNL complications and found that patients with SCI reported a signi cantly greater rate of grade I (OR 9.54; 95% CI, 3.06-29.79; I 2 = 61%, p = 0.08), grade II (OR 3.38; 95% CI, 1.85-6.18; I 2 = 58%, p = 0.07), and grades III-V complications (OR 2.38; 95% CI, 1.35-4.19; I 2 = 50%, p = 0.11) following PCNL compared to the non-SCI cohort (Fig.…”

Section: Postoperative Complicationsmentioning

confidence: 99%

Postoperative outcomes of kidney stone surgery in patients with spinal cord injury: a systematic review and meta-analysis

Kim

Stewart

Talwar

et al. 2022

Preprint

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Spinal cord injury (SCI) is associated with an increased risk of nephrolithiasis. We performed a systematic review and meta-analysis to assess stone clearance and complication rates following surgical treatment of kidney stones in this population. We systematically reviewed the Ovid MEDLINE, Embase, CENTRAL, and Web of Science databases for studies examining outcomes of kidney stone procedures in SCI patients. Our primary outcomes were stone-free rate (SFR) and complications, as categorized by Clavien-Dindo classification. A meta-analysis of comparative studies was performed to assess differences in outcomes between SCI and non-SCI patients following PCNL. A total of 27 retrospective and observational articles were included. Interventions for kidney stones included PCNL, shockwave lithotripsy (SWL), and ureteroscopy. Pooled SFR in SCI patients undergoing surgery for kidney stones was 54.1%, for SWL, 73.6% for PCNL, and 36.2% for ureteroscopy. Four studies compared outcomes following PCNL in SCI and non-SCI patients. Meta-analysis found that there were higher rate of grades I (OR 9.54; 95% CI, 3.06-29.79), II (OR 3.38; 95% CI, 1.85-6.18), and III-V (OR 2.38; 95% CI, 1.35-4.19) complications in SCI patients compared to non-SCI patients following PCNL. The rate of infectious complications was also higher in patients with SCI (OR 6.15; 95% CI, 1.86-20.39). However, there was no difference in SFR (OR 0.64; 95% CI, 0.15-2.64) between groups. Patients with SCI are at higher risk of complications following PCNL compared to non-SCI patients. SFR after PCNL was equivalent between groups, suggesting that PCNL is an effective surgery for kidney stones in SCI patients.

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Percutaneous nephrolithotomy in patients with spinal cord injury: should all these patients be automatically assigned a Guy’s stone score of 4?

Cited by 7 publications

References 19 publications

Clinical Efficacy and Safety of Percutaneous Spinal Endoscopy versus Traditional Open Surgery for Lumbar Disc Herniation: Systematic Review and Meta-Analysis

Clinical Efficacy and Safety of Percutaneous Spinal Endoscopy versus Traditional Open Surgery for Lumbar Disc Herniation: Systematic Review and Meta-Analysis

Tranexamic acid in patients with complex stones undergoing percutaneous nephrolithotomy: a randomised, double‐blinded, placebo‐controlled trial

Postoperative outcomes of kidney stone surgery in patients with spinal cord injury: a systematic review and meta-analysis

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