Percutaneous Nephrolithotomy in Spinal Cord Neuropathy Patients: A Single Institution Experience

Nabbout, Philippe; Slobodov, Gennady; Mellis, Adamantios M.; Culkin, Daniel J.

doi:10.1089/end.2012.0344

Cited by 23 publications

(16 citation statements)

References 16 publications

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“…SCI patients represent a unique group that is associated with multiple co-morbidities, and increased risk of mortality and postoperative complication rate [1][2][3][4][5][6][7][8][9][10][11][12]14]. The most serious urologic complications of SCI and neurogenic bladder dysfunction include the formation of vesicoureteral reflux and hydronephrosis, renal failure, urolithiasis, UTI, bladder cancer, and sexual dysfunction [15].…”

Section: Discussionmentioning

confidence: 99%

“…As surgeons gain experience, it can be used for even the most challenging cases. The literature contains limited references to SCI patients treated with PNL [7][8][9][10][11][12]. PNL is a proper treatment modality for patients with a large stone burden and staghorn renal calculi, as commonly found in SCI patients.…”

Section: Discussionmentioning

confidence: 99%

“…PNL is a proper treatment modality for patients with a large stone burden and staghorn renal calculi, as commonly found in SCI patients. The success rate for a single PNL session is between 53.8 and 62 % [7][8][9][10][11][12]. However, additional PNL sessions are reported to increase the stone-free rate up to 96 % [8].…”

Section: Discussionmentioning

confidence: 99%

“…However, additional PNL sessions are reported to increase the stone-free rate up to 96 % [8]. In a recently published study, the success rate after a mean of 2 PNL sessions in patients with an average of 31.3 mm renal stone burden was reported to be 88.5 % [9]. On the other hand, the complication rate of PNL is reported to be higher in SCI patients compared to ambulatory patients, because of the increased comorbidities of SCI patients.…”

Section: Discussionmentioning

confidence: 99%

“…The main factors complicating treatment of urolithiasis in SCI patients include (1) an increased risk of urinary tract infection (UTI) and urosepsis related to neurogenic bladder dysfunction, (2) patient positioning difficulties related to contracture of the extremities, and (3) risks secondary to accompanying co-morbidities. The literature contains a limited number of studies presenting the outcomes of ureteroscopy (URS) [6,7] or percutaneous nephrolithotomy (PNL) [7][8][9][10][11][12] in this specific patient group.…”

Section: Introductionmentioning

confidence: 99%

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Flexible ureteroscopic laser lithotripsy for upper urinary tract stone disease in patients with spinal cord injury

2015

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The objective of this study is to present the outcomes of flexible ureteroscopic laser lithotripsy (URS) for upper urinary tract stone disease in spinal cord injury (SCI) patients performed by a single surgeon. A retrospective analysis was performed for SCI patients treated with flexible URS for proximal ureter and kidney stone disease by a single surgeon between 2003 and 2013. Patient characteristics, operative outcomes, metabolic evaluation, and stone analyses were assessed in detail. A total of 27 URS procedures were performed for urolithiasis in 21 renal units of 19 patients. The mean age was 52.1 ± 15.6 years (16-72) and mean BMI was 29.2 ± 7.3 kg/m(2) (20-45.7). Etiology of SCI was trauma (n: 10), multiple sclerosis (n: 6), cerebrovascular accident (n: 1), or undetermined (n: 2). The mean stone size was 15.9 ± 8.6 (6-40) mm. In the 27 URS procedures, stones were located in the ureter (n: 5), the kidney (n: 14), and both areas (n: 8). Mean hospitalization time was 2.0 ± 2.4 (0-10) days. Postoperative complications were observed in 6 cases (22.2%). Three major complications included urosepsis (n: 1) and respiratory failure (n: 2), that were observed postoperatively and required admission to the intensive care unit. The 2 minor complications were hypotension, fever and UTI, and required medical treatment. Fourteen (66.6%) of the 21 renal units were stone free. Calcium phosphate carbonate (n: 9) and struvite (n: 5) were the primary stone compositions detected. Hypocitraturia (n: 6), hypercalciuria (n: 5), hypernaturia (n: 5), hyperoxaluria (n: 4), and hyperuricosuria (n: 1) were common abnormalities in 24-h urine analysis. Ureteroscopic laser lithotripsy can be an effective treatment modality for SCI patients with upper urinary tract calculi.

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