Outcomes of renal calculi in patients with spinal cord injury

Abstract

Aims: Patients with spinal cord injury (SCI) are at risk of developing renal calculi. This study describes the management of renal calculi among patients with SCI with attention to factors influencing surgical management vs observation. Methods: This retrospective, cohort study identified patients with SCI and renal calculi between 2009 to 2016 from an institutional neurogenic bladder database and detailed the management of their stones. A stone episode was defined as radiographic evidence of new calculi.Results: Of 205 patients with SCI, 34 had renal stones, for a prevalence of 17%. The mean age was 50 years (range 22,77) and most had cervical SCI (n = 22,

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

“…This increased the specificity but decreased the sensitivity of detecting people with stones; for example, this helped us exclude people with isolated nephrocalcinosis but also meant we missed people who passed their stones spontaneously without surgical intervention. 8 Secondary to this, our study underestimates the overall incidence of stone disease in those with SCI as only surgical stone data was analyzed. Additionally, participants with a history of both bladder and kidney stones were grouped with the kidney stone group because kidney stones often pose a greater risk of complications, including cardiovascular risk, chronic pain, pyelonephritis and renal dysfunction.…”

“…These factors may cause surgery to be deferred until the patient is symptomatic. In an analysis by Lane et al 8 including 34 individuals with SCI and nephrolithiasis, only 14 (41%) patients with stones required surgical management for indications such as pain or infection. Chen et al similarly described conservative management of stones in 60 patients with SCI and renal stones and found that 82% of stones resolved (no longer detectable on abdominal X‐ray) without surgical intervention 4 .…”

“…We used prior stone surgery as a proxy for a history of stones. This increased the specificity but decreased the sensitivity of detecting people with stones; for example, this helped us exclude people with isolated nephrocalcinosis but also meant we missed people who passed their stones spontaneously without surgical intervention 8 . Secondary to this, our study underestimates the overall incidence of stone disease in those with SCI as only surgical stone data was analyzed.…”

“…While those with minimal stone burden may be observed, some require intervention, particularly if the stones are associated with infections, obstruction, or declining renal function. In those with SCI, stone surgery has complication rates exceeding 20% and poor stone‐free rates with potential need for repeat treatments and stone‐related events 7,8 . To our knowledge, there is no prior study describing the long‐term morbidity and quality‐of‐life (QOL) among people with SCI and a history of urolithiasis requiring surgical intervention.…”

“…In those with SCI, stone surgery has complication rates exceeding 20% and poor stone-free rates with potential need for repeat treatments and stonerelated events. 7,8 To our knowledge, there is no prior study describing the long-term morbidity and quality-oflife (QOL) among people with SCI and a history of urolithiasis requiring surgical intervention. We hypothesized that a history of surgically managed stone disease would be associated with an increased incidence of SCIrelated complications and lower QOL compared to individuals with SCI without a stone history.…”