Percutaneous Nephrolithotomy: Spinal Cord Injury vs. Ambulatory Patients

Abstract

One hundred patients, 35 with spinal cord injury (SCI) and 65 who were ambulatory, underwent percutaneous nephrolithotomy (PNL). Success of complete stone excision, operative morbidity and mortality were compared in the two patient populations. Stone size and complexity were evaluated by X-ray and a single-stage PNL was done using general anesthesia, bi-planar C-arm fluoroscopy, Amplatz renofascial dilators, and two guide wires. Eleven percent of the patients had previously-placed percutaneous nephrostomy tubes for hydronephrosis and/or pyonephrosis. In the ambulatory group, 98.5% (64/65) were stone-free after the procedure as compared to 85.7% (31/35) in the SCI group. The success rate in those patients who followed postoperative instructions exceeded 96% in both groups of patients. One operative mortality, related to infectious complications, occurred in the SCI group. Major morbidity in the SCI population consisted of three perirenal abscesses, a hydrothorax, an aspiration pneumonia, a respiratory arrest and a nephro-colonic fistula for a rate of 20% (7/35), or 7% of all patients. One major complication, a nephroduodenal fistula, occurred in the ambulatory population. Four patients, three of whom were SCI, required open surgery related to infectious complications. Other significant complications consisted of hemorrhage requiring transfusion, and fever (101.5 degrees F). Minor complications included dislodged nephrostomy tubes, retained stones, and ureteral edema causing obstruction. These complications were three times more common in the SCI population. Percutaneous nephrolithotomy is an effective surgical means for stone removal for SCI and ambulatory patients. The SCI patient has a high incidence of infectious complications causing increased morbidity and mortality.

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.…”

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

“…SCI patients represent a unique group that is associated with multiple co-morbidities, and increased risk of mortality and postoperative complication rate [1][2][3][4][5][6][7][8][9][10][11][12]14]. The most serious urologic complications of SCI and neurogenic bladder dysfunction include the formation of vesicoureteral reflux and hydronephrosis, renal failure, urolithiasis, UTI, bladder cancer, and sexual dysfunction [15].…”

“…The main factors complicating treatment of urolithiasis in SCI patients include (1) an increased risk of urinary tract infection (UTI) and urosepsis related to neurogenic bladder dysfunction, (2) patient positioning difficulties related to contracture of the extremities, and (3) risks secondary to accompanying co-morbidities. The literature contains a limited number of studies presenting the outcomes of ureteroscopy (URS) [6,7] or percutaneous nephrolithotomy (PNL) [7][8][9][10][11][12] in this specific patient group.…”

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.…”