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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