Percutaneous Nephrolithotomy in the Spinal Cord Injury Population

Abstract

We evaluated 23 male spinal cord injury patients who underwent percutaneous nephrolithotomy for the success rate of stone removal and the incidence of operative complications. There were 18 quadriplegic and 5 paraplegic patients, and 5 had bilateral procedures. Of the kidneys 7 had staghorn calculi, 8 had pelvic and caliceal combinations, 6 had large multiple caliceal stones, 4 had large (more than 2.5 cm.) pelvic stones and 3 had pelvic stones less than 2.5 cm. Placement of a nephrostomy tube and stone extraction were performed as a single procedure with the use of general anesthesia in all but 4 patients. Our results showed that 19 of 21 compliant patients (90.4 per cent) were free of stone, with an average of 2.04 procedures per patient. A total of 47 procedures was performed, with an average operative time of 1 hour 45 minutes. Major complications were associated with 4 of the 47 procedures (8.5 per cent), and consisted of a respiratory arrest, 2 perirenal abscesses and a hydrothorax. Minor complications included fever (more than 101.5F) in 64.3 per cent and retained stones in 14.3 per cent of the kidneys operated upon, dislodged nephrostomy tubes in 12.6 per cent of the procedures (21.4 per cent of the kidneys operated upon), and anemia requiring transfusion in 17.0 per cent (8 of 47) of the procedures (27.8 per cent of the kidneys operated upon). The presence of infected stones, prior operative procedures and medical complexity of these patients make complications more frequent. Nevertheless, percutaneous nephrolithotomy is a safe and effective procedure for the spinal cord injury population.

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

“…PCNL is the gold standard for stones measuring 2 cm and above in the renal pelvis and this remains the case in patients with SCI. Five published series [26][27][28][29][30] report stone-free rates of around 90%, which at first look appears comparable to the standard PCNL outcomes. (Table 4) However, in the Chicago series all patients had a second-look PCNL as standard, and only 19 renal units were stone free after first PCNL in the UK series.…”

“…28,30 In the earliest study from 1986, there was an average of 2.04 procedures per patient. 26 In this respect, PCNL in patients with SCI is a more complex and significantly undertaking, often requiring multiple procedures to achieve stone clearance. In the major part of the more contemporary series, 13 out of the 54 procedures required multiple punctures and 23 punctures were supracostal.…”

Surgical Challenge of Massive Bilateral Staghorn Renal Calculi in a Spinal Cord Injury Patient

“…Furthermore, Lechevallier et al [13] reported a higher likelihood for renal scar formation after ESWL sessions than after percutaneous nephrolithotomy [13]. Therefore, treatment options were directed towards a percutaneous surgical approach [14][15][16][17], open surgical approach [18], or various combinations of multi-modality treatments [8,19,20]. The decision to perform percutaneous nephrolithotomy in our patient rather than open surgery was influenced by a variety of factors.…”

Ureteroscopy with laser lithotripsy for urolithiasis in the spinal cord injury population

“…2,4,5 In the SCI population, average clearance rates using SWL are 44-55%, [9][10][11] and percutaneous nephrolithotripsy clearance rates are 54-87%. 12,13 One possible explanation for the high failure rate of URS in the SCI population may be that chronic neurogenic bladder dysfunction can cause fibrosis and bladder wall contractures which alter the ureteral orifice and urethral anatomy. 14 In addition, patients with SCI often suffer from lower extremity contractures making positioning in the lithotomy position difficult or impossible.…”