The management of upper urinary tract calculi by piezoelectric extracorporeal shock wave lithotripsy in spinal cord injury patients

Abstract

, 15 spinal cord injury patients were treated by piezoelectric extracorporeal shock wave lithotripsy. Aged from 23 to 71 years (mean = 39), they presented with a total of 23 stones, of which 18 were located in the calyces, three in the renal pelvis and two in the proximal ureter. The maximum dimensions of calculi varied from 5 to 35 mm (mean = 11). Patients were placed in a dorsal decubitus position during the sessions, three being sedated with diazepam, while the other 12 remained unsedated.All were treated routinely with systemic antibiotics. Auxiliary procedures consisted of two pyelocalyceal flushings, three double J ureteral stenting and three ureteroscopies with fragment removal with a Dormia basket. No episode of autonomic dysreflexia was observed. Short term side effects were limited to a few cases of gross haematuria which regressed spontaneously. Overall, eight successes (53%), and seven failures (47%), were registered. Of the failures, one was the result of a partial fragmentation, while six were related to intrarenal retention of residual fragments resulting in four cases in rapid recurrences. Extracorporeal shock wave lithotripsy can be easily applied to spinal cord injury patients. Its usefulness and limitations need to be well understood and a global consideration must be applied to the prevention and early detection of the upper urinary calculi in this exposed population of patients.

Outcome from percutaneous nephrolithotomy in patients with spinal cord injury, using a single‐stage dilator for access

“…Furthermore, because of positioning problems related to the potential kyphoscoliosis and pelvic tilt, and consequent difficulties in the accurate location of shock‐waves on renal calculi for lithotripsy, these patients might be at greater risk of developing renal parenchymal and vascular damage after ESWL [19]. The potential long‐term effects on renal parenchyma dictate strict control of its repeated use [18]. Other common issues that arise with ESWL are the elimination of stone fragments that can cause obstruction, and incomplete stone clearance permitting ongoing infection and nephrolithiasis [18].…”

“…The potential long‐term effects on renal parenchyma dictate strict control of its repeated use [18]. Other common issues that arise with ESWL are the elimination of stone fragments that can cause obstruction, and incomplete stone clearance permitting ongoing infection and nephrolithiasis [18].…”

“…A review of series reporting stone treatment with PCNL, ESWL or combined treatments in patients with SCI identifies overall success rates of 38-89% (Table 3) [2,5,[13][14][15][16][17][18]. In the present series of 26 patients, the number of PCNLs was 1.69 per kidney treated, remarkably similar to other series of PCNL (1.44 and 1.67) [2,13].…”

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

“…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.…”

Iatrogenic urological triggers of autonomic dysreflexia: a systematic review

“…Kabalin et al 54 reported that without anesthesia 19 out of the 20 individuals developed AD during ESWL. In another study conducted by Robert et al 55 using piezoelectric ESWL, only 3 out of the 11 individuals received sedation and yet no episodes of AD occurred in any individuals. Stowe et al 31 reported that 6 out of the 22 cervical SCI patients with spinal anesthesia developed AD.…”