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

Abstract

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.

Advances in Lasers for the Treatment of Stones—a Systematic Review

“…Ho:YAG laser lithotripsy is an efficient and safe technology for the treatment of urinary stones in almost any patient group, ranging from young children to adults and older patients, pregnant women to spinal cord injury patients, from solitary to allograft kidneys, or patients on certain medications and anticoagulants. Its safety profile has been largely demonstrated and still is in countless and recent safety-oriented studies [ 87 •, 88 •, 89 , 90 •, 91 – 98 , 99 •, 100 , 101 •]. Yet there are still some direct and indirect complications and safety concerns about laser lithotripsy, which have been recently researched.…”

Flexible ureteroscopy lithotripsy combined with metallic ureteral stents for the treatment of patients with upper urinary tract calculi

“…Currently, FURS is most commonly used in the treatment of patients with proximal ureteral and renal calculi (20). A previous study indicated that ureteroscopic laser lithotripsy can be used as an effective treatment modality for patients with spinal cord injury and with upper urinary tract calculi (21). Additionally, MUS can be used in the treatment of malignant ureteral obstruction (22).…”

Retrospective Analysis of Ultrasound-guided Flexible Ureteroscopy in the Management of Calyceal Diverticular Calculi

“…FURS is specifically indicated for professionals including airline and air force pilots, young women who do not wish to manifest surgical scars, and even pregnant women. [710162930] Traditional PCNL in the prone position has a higher surgical risk for some patients, such as those with severe kyphosis, cardiopulmonary dysfunction, obesity, or spinal cord injury. The oblique supine lithotomy position, on the other hand, is more comfortable and better tolerated by patients and is a familiar position for surgical staff, thus minimizing anesthetic and operative risks.…”

“…The oblique supine lithotomy position, on the other hand, is more comfortable and better tolerated by patients and is a familiar position for surgical staff, thus minimizing anesthetic and operative risks. [7810202130] Therefore, the beneficial implications for FURS treatment for calyceal diverticular stone in the oblique supine lithotomy position are broader than for PCNL. In the present study, two asymptomatic patients included a pilot and an astronaut with diverticular stones found during the physical examination.…”