Safety and efficacy of percutaneous nephrolithotomy in patients with neurogenic bladder dysfunction

Rubenstein, Jonathan N.; Gonzalez, Christopher; Blunt, Lynn W.; Clemens, J. Quentin; Nadler, Robert B.

doi:10.1016/j.urology.2003.11.027

Cited by 48 publications

(28 citation statements)

References 14 publications

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“…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.…”

Section: Ureteroscopicmentioning

confidence: 73%

“…(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.…”

Section: Ureteroscopicmentioning

confidence: 99%

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

Ramsey

McIlhenny

2011

Spinal Cord

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Objective: The objective is to review the published literature on the aetiology and evidence-based management of stone disease in the spinal cord-injured patient. Methods: A PubMed and Medline search was performed using the terms 'spinal cord injury', 'paraplegia', 'stone', 'nephrolithiasis', 'urolithiasis', 'calculus', 'spinal cord injury' or 'paraplegia' with 'SWL', 'ureteroscopy', 'chemolysis' and 'PCNL.' The Cochrane database, the National Institute for Clinical Excellence guidelines and the Scottish Intercollegiate guidelines were searched using the terms 'spinal cord injury' and 'urolithiasis' and 'nephrolithiasis'. Results: A total of 32 papers were identified, mainly case series or case-cohort studies with few contemporary papers. The risk of developing a renal stone after spinal cord injury (SCI) is between 7 and 20% over a period of 8-10 years. Stone formation may be related to early demineralisation of bone or chronic infection. Biochemical abnormalities are not significantly different between stone-forming and non-stone forming patients, though these patients differ from healthy controls. Presentation may be atypical, but is most commonly recurrent urinary tract infection. Treatment may be complicated by lower limb contractures limiting retrograde access. Several case series report success with shock wave lithotripsy varying from 50 to 70%, though comparisons are limited by heterogeneous indications and reporting. Percutaneous nephrolithotomy remains the gold standard for stones measuring 2 cm and above. Stone-free rates of 90% have been reported, though surgery was often complex with higher complication rates. Conclusion: Management of upper urinary tract stones in patients with SCI is complex regarding surgical technique, post-operative care and recurrence rates. Further contemporary case series must use standardised reporting tools to allow valid comparisons.Spinal Cord (2011) 49, 948-954;

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Section: Ureteroscopicmentioning

confidence: 73%

Section: Ureteroscopicmentioning

confidence: 99%

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

Ramsey

McIlhenny

2011

Spinal Cord

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“…La nefrolitotomía percutánea es un método de tratamiento eficaz tanto en pacientes con MMC y derivación urinaria 19 como en aquellos que presentan cálculos en su vía urinaria nativa 20 . Se recomienda recoger muestras de orina piélica para cultivo durante su realización.…”

Section: Discussionunclassified

Litiasis urinaria en adultos con mielomeningocele

Tartajo

Casado

Amo

et al. 2006

Actas Urológicas Españolas

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Introducción y objetivos: Los avances en el tratamiento de los nacidos con mielomeningocele (MMC) han logrado un gran aumento en su supervivencia, permitiéndoles una longevidad nunca antes alcanzada, pero todavía son escasos los datos concernientes a los problemas urológicos que estos enfermos plantean durante su vida adulta. Hemos evaluado las características de la litiasis urinaria en adultos nacidos con MMC así como los tratamientos empleados en la misma. Material y métodos: Revisamos 52 pacientes nacidos con MMC de entre 18 y 40 años, atendidos durante los últimos 14 años en nuestro hospital, con una media de seguimiento de 6,7 años. Resultados: Se diagnosticaron de litiasis urinaria 10 pacientes (19,2%). Tres formaron cálculos renales (5,7%), y uno de ellos, junto con 7 pacientes más, desarrollaron cálculos vesicales (15,3%). El nivel neurológico fue ≤ L 2 en 3 casos, L 2-S 1 en 5, y ≥ S 1 en otros dos. El tipo de disfunción neurógena del tracto urinario inferior fue de lesión múltiple pura de neurona motora inferior en 6 casos, de neurona motora superior en 1, lesión múltiple mixta en otro, no pudiéndose valo-rar en el restante. Dos pacientes tenían una ampliación vesical y uno de estos junto con otros 3 pacientes era portador de AMS-800 no funcionantes. La litiasis vesical se trató endoscopicamente en 14 ocasiones y mediante cistolitotomía suprapúbica en 4, junto a la retirada de AMS-800 en 3 de ellas. Un paciente expulsó un pequeño cálculo. En un pacien-te fueron necesarias 2 litotricias extracorpóreas y 2 nefrolitotomías percutáneas. Tres pacientes tuvieron múltiples reci-divas. Conclusiones: La litiasis urinaria es frecuente en los adultos con MMC. Determinadas características de estos pacien-tes, junto con su configuración anatómica y algunos tratamientos empleados en ellos, ocasionan problemas de diagnos-tico, tratamiento y prevención de los cálculos que forman. ABSTRACT URINARY CALCULI IN MYELOMENINGOCELE ADULTS Introduction and objectives: the improvements in the management of newborns with myelomeningocele (MMC) have obtained a big increase in survival, allowing them to get longevity like never before, but data regarding urologic diseases during adult age are still missing. We herein evaluate the features of urinary lithiasis in adults born with MMC and the therapies used for its treatment. Material and method: we review 52 patients diagnosed at birth of MMC, between 18 and 40 years old, treated in our institution, with a mean follow-up of 6.7 years. Results: 10 patients (19.2%) were diagnosed of urolithiasis. Three developed kidney calculi and one of them, with 7 more patients, developed bladder calculi (15.3%). The neurological level was ≤ L2 in 3 cases, L2-S1 in 5, and ≥ S1 in the other two. The type of neurogenic dysfunction of inferior urinary tract was multiple lesion of lower motor neurone in 6 cases, upper motor neurone in 1 case, multiple mixed lesion in 1 case and in case it was impossible to determine. Two patients had a bladder augmentation procedure and one of these with other 3 patie...

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

2015

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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.

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Safety and efficacy of percutaneous nephrolithotomy in patients with neurogenic bladder dysfunction

Cited by 48 publications

References 14 publications

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

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

Litiasis urinaria en adultos con mielomeningocele

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

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