Surgical Management of Urolithiasis in Spinal Cord Injury Patients

Nabbout, Philippe; Slobodov, Gennady; Culkin, Daniel J.

doi:10.1007/s11934-014-0408-3

Cited by 11 publications

(7 citation statements)

References 42 publications

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“…We have also previously shown that indwelling catheters are associated with an increased risk of UTIs and hospitalization for UTIs, in this same cohort 22 . This may be associated with the fact that infections, particularly with Proteus infections, are linked to the formation of stones, like struvite (magnesium ammonium phosphate), one of the most common stones in this population 23 . Interestingly, we found that people with a history of kidney or bladder stones did not have a significantly higher rate of patient‐reported UTIs but did have an increased rate of hospitalizations due to UTI in the year before enrollment.…”

Section: Discussionsupporting

confidence: 51%

“…22 This may be associated with the fact that infections, particularly with Proteus infections, are linked to the formation of stones, like struvite (magnesium ammonium phosphate), one of the most common stones in this population. 23 Interestingly, we found that people with a history of kidney or bladder stones did not have a significantly higher rate of patient-reported UTIs but did have an increased rate of hospitalizations due to UTI in the year before enrollment. The reasons for this discrepancy are unclear but may be related to the fact that recall for hospitalizations may be more accurate than UTIs.…”

Section: Discussionmentioning

confidence: 65%

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Association of stone surgery with patient‐reported complications after spinal cord injury

Kasabwala

Borofsky

Grove

et al. 2022

Neurourology and Urodynamics

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Aims To determine if a history of urinary stone surgery in individuals with spinal cord injury (SCI) is associated with an increased incidence of SCI‐related complications and lower quality of life (QOL). Methods The Neurogenic Bladder Research Group (NBRG) registry is a multicenter, prospective, observational study which measures QOL after acquired SCI. Over 1.5 years, 1479 participants were enrolled and grouped according to history of stone surgery. We evaluated SCI‐related complications, QOL, and associations between patient factors and prior stone surgery using multivariable regression. Results Participants were a median of 11 years post‐SCI and 189 (12.8%) reported prior bladder or kidney stone surgery; 95.8% of these occurred after the SCI. Median time between SCI and first stone was 5.6 years (IQR: 1.8–12.8). Hospitalizations were higher for those with prior stone surgery, with common reasons including UTIs, blood clots, pressure ulcers, and pneumonia (p < 0.001). During the year of observation, the incidence of stone surgery was 17% in those with a prior history of stone surgery and 2% per year in those without prior stone surgery (p < 0.001). Controlling for covariates, bladder management strategy, age, BMI, and years since SCI were associated with history of stone surgery. Conclusions People with SCI and a history of surgical stone disease are at high risk for episodes of recurrent stones and increased hospitalizations, particularly those with kidney stones and indwelling catheter use. Identification of high‐risk patients may guide tailored surveillance for complications and stone prevention strategies.

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Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 65%

Association of stone surgery with patient‐reported complications after spinal cord injury

Kasabwala

Borofsky

Grove

et al. 2022

Neurourology and Urodynamics

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“…One of the main reasons for avoiding surgical treatment for patients with poor PS is the risk of perioperative complications, especially infectious disease. A review of the current literature on the management of urolithiasis in patients with spinal cord injury showed that the overall complication rate in patients with spinal cord injury is higher than in the general population, and the majority of these are infectious in nature are due to the associated medical comorbidities and chronic bacteriuria [ 5 ]. In our study, postoperative pyelonephritis was observed in 16.7% (1/6 cases), 15.4% (6/39 cases) and 16.7% (1/6 cases) of the patients who underwent SWL, URS and PCNL, respectively.…”

Section: Discussionmentioning

confidence: 99%

Upper urinary tract stone disease in patients with poor performance status: active stone removal or conservative management?

et al. 2017

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BackgroundIt remains controversial as to whether active stone removal should be performed in patients with poor performance status because of their short life expectancy and perioperative risks. Our objectives were to evaluate treatment outcomes of active stone removal in patients with poor performance status and to compare life prognosis with those managed conservatively.MethodsWe retrospectively reviewed 74 patients with Eastern Cooperative Oncology Group performance status 3 or 4 treated for upper urinary tract calculi at our four hospitals between January 2009 and March 2016. Patients were classified into either surgical treatment group or conservative management group based on the presence of active stone removal. Stone-free rate and perioperative complications in surgical treatment group were reviewed. In addition, we compared overall survival and stone-specific survival between the two groups. Cox proportional hazards analysis was performed to investigate predictors of overall survival and stone-specific survival.ResultsFifty-two patients (70.3%) underwent active stone removal (surgical treatment group) by extracorporeal shock wave lithotripsy (n = 6), ureteroscopy (n = 39), percutaneous nephrolithotomy (n = 6) or nephrectomy (n = 1). The overall stone-free rate was 78.8% and perioperative complication was observed in nine patients (17.3%). Conservative treatment was undergone by 22 patients (29.7%) (conservative management group). Two-year overall survival rates in surgical treatment and conservative management groups were 88.0% and 38.4%, respectively (p < 0.01) and two-year stone-specific survival rates in the two groups were 100.0% and 61.3%, respectively (p < 0.01). On multivariate analysis, stone removal was not significant, but was considered a possible favorable predictor for overall survival (p = 0.07). Moreover, stone removal was the only independent predictor of stone-specific survival (p < 0.01).ConclusionsActive stone removal for patients with poor performance status could be performed safely and effectively. Compared to conservative management, surgical stone treatment achieved longer overall survival and stone-specific survival.Electronic supplementary materialThe online version of this article (10.1186/s12894-017-0293-4) contains supplementary material, which is available to authorized users.

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“…SCI patients pose a particular challenge because of their multiple comorbidities, skeletal deformities, previous surgeries, urinary diversions and chronic bacteruria. 5 Open cystolithotomy was historically the procedure of choice, offering excellent stone clearance but with high complication rates and associated morbidity. Particularly, large stones may still require an open procedure; however, the majority of bladder stones in SCI patients are now treated as in the general population: transurethrally with stone punch, electrohydraulic lithotripsy (EHL) or holmium YAG laser, percutaneously, or with extracorporeal shock wave lithotripsy (ESWL).…”

Section: Introductionmentioning

confidence: 99%

“…Particularly, large stones may still require an open procedure; however, the majority of bladder stones in SCI patients are now treated as in the general population: transurethrally with stone punch, electrohydraulic lithotripsy (EHL) or holmium YAG laser, percutaneously, or with extracorporeal shock wave lithotripsy (ESWL). The overall complication rate following bladder stone removal in SCI patients is thought to be higher than in the general population; 5 however, there is very limited documentation of the outcomes associated with any of these techniques either in the general population or in SCI patients.…”

Section: Introductionmentioning

confidence: 99%

Morbidity associated with operative management of bladder stones in spinal cord-injured patients

Eyre

Reynard

2015

Spinal Cord

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Study design: Retrospective cohort study of spinal cord-injured (SCI) patients undergoing bladder stone removal operations between 1999 and 2013. Objectives: To determine the morbidity associated with different operative management of bladder stones in SCI patients. Setting: National Spinal Injuries Unit, Stoke Mandeville Hospital, UK. Methods: Data on age, sex, level and Frankel classification of spinal cord injury, method of bladder drainage, method of bladder stone removal, complications and length of stay were collected from patient records. Complication was defined as bladder perforation, sepsis or persistent haematuria. Predictors of complications and length of stay were determined using univariate and multivariate regression analyses. Results: Overall, 112 consecutive bladder stone removal operations were performed, one open cystolithotomy and 111 transurethral procedures utilising simple washout, stone punch or electrohydraulic lithotripsy (EHL). Of these procedures, 17% (19/112) had complications; 0/11 (0%) following washout, 5/44 (11%) after stone punch, 3/12 (25%) following EHL and 10/26 (38%) after combined procedures using stone punch and EHL. In a multivariate model, patients with a cervical-level injury and those undergoing a combined procedure were significantly more likely to have a complication (P = 0.032 and P = 0.046). Length of stay was longer following a complication, the mean was 4.18 days compared with 1.37 days without a complication (Po0.001). Controlling complications and age, use of a combined procedure was associated with significantly longer stay than use of stone punch alone. Conclusion: This study provides important outcome data that should guide operative procedure choice and inform patients about possible risks during consent. It sets a benchmark that other centres can evaluate their outcomes against.

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Surgical Management of Urolithiasis in Spinal Cord Injury Patients

Cited by 11 publications

References 42 publications

Association of stone surgery with patient‐reported complications after spinal cord injury

Association of stone surgery with patient‐reported complications after spinal cord injury

Upper urinary tract stone disease in patients with poor performance status: active stone removal or conservative management?

Morbidity associated with operative management of bladder stones in spinal cord-injured patients

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