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

Abstract

Study design: Retrospective study. Objectives: The purpose of this investigation was to review the outcomes and safety of retrograde ureteroscopic laser lithotripsy (URS) for the treatment of urolithiasis in the spinal cord injury (SCI) population. Setting: Virginia, USA. Methods: All patients with SCI who underwent URS with holmium:YAG laser lithotripsy for urolithiasis over a 15-year period were identified. Stone size, location and number at presentation were recorded. Information regarding patient characteristics, intra-operative complications, surgical efficacy, stone clearance, peri-operative complications, and follow-up stone events was collected and analyzed. Results: A total of 67 URS procedures were performed on 29 SCI patients during the study period with an average follow-up of 3.4 years. Patients had an average of 2.3 ipsilateral ureteroscopies. The majority (85.1%) used indwelling catheters for long-term bladder management, and complete stone clearance after the first procedure was 34.3%. Of the 44 cases with residual stones 44 mm, 20 (45.5%) were secondary to technical or procedural limitations. The intra-operative complication rate was comparable to non-SCI studies at 1.5%, but peri-operative complications were significantly higher at 29.9% with the majority due to urosepsis. Factors associated with peri-operative complications include chronic obstructive pulmonary disease, motor incomplete injuries and lack of a pre-operative ureteral stent. Conclusion: URS in the SCI population is an effective treatment for ureteral or renal stones but may be associated with greater risks and reduced efficacy. With advances in endourology, ureteroscopic surgery has become a popular choice for the minimally invasive treatment of urolithiasis. In the general population, studies reveal stone-free rates between 77 and 93% after one procedure. Success varies depending on size, number and location of stones. 2-5 Intra-operative complications range between 0 and 6%, and major peri-operative complications between 1 and 3%. 2,4,6 Unfortunately, it is not known whether these studies are directly applicable to patients with SCI. SCI results in neurogenic bladder, which significantly alters bladder function including ability to empty, bladder pressure, continence and bladder compliance. 7 Detrusor-sphincter-dyssynergia, a common problem in SCI patients with neurogenic bladder dysfunction, can cause elevated detrusor

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

“…Wolfe and associates reported complications in 29.9 % of the procedures in their study [6]. The most common complications were urosepsis (17.9 %), respiratory failure (4.5 %), and acute outlet obstruction (4.5 %).…”

“…Its minimally invasive nature and reduced risk of complications are the main advantages compared to PNL. The use of URS in SCI patients is reported by two recently published studies [6,7]. Welk et al [7] evaluated 5121 patients who had experienced an SCI in the previous 9 years and investigated surgical interventions for kidney stones.…”

“…In the second study, Wolfe et al [6] evaluated 29 SCI patients treated with 67 URS sessions for urolithiasis over a 15-year period. The mean URS sessions per patient were 2.…”

“…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.…”