Category: Clinical Stones: Ureteroscopy
Introduction & Objective :
Managing kidney stone disease (KSD) in spinal cord injured (SCI) patients is complex. Minimal data is available regarding treatment outcomes in this group of patients. We present the largest UK series of ureterorenoscopy (URS) in SCI patients and compare outcomes with a non-neurogenic population.
A retrospective analysis was made of all SCI patients undergoing URS and laser lithotripsy between 2005-17 in our unit. A comparison was made with non-neurogenic patients undergoing similar procedures.
In the SCI group complications occurred in 10 cases (24%), all were Clavien-Dindo grade II.
Stone recurrence occurred in 16 cases (42%); 4 within 12 months (10.5%) and 12 after a year (31.6%). Further intervention within a year was required in 18 cases (44%) and 7 of these were planned multi-stage procedures. The stone-free rate at 12 months was 47%.
In the non-neurogenic cohort complications occurred in 3 cases (7%), all were clavien-dindo grade II (clot colic, NSTEMI and aspiration on induction).
Stone recurrence occurred in 6 cases; 2 within 12 months (5%) and 4 after a year (10%). Further intervention within a year was required in 2 cases (5%), but these were both planned procedures. The stone free rate was 86% at follow up (between 3 months to 3 years).
SCI patients undergoing URS for KSD have a higher complication rate increased length of stay when compared to non SCI patients. Potential explanations for this include altered physiology, urinary tract bacterial colonisation and previous urinary tract reconstruction. Stone free rates are also lower in SCI patients but this may be at least in part due to larger average stone size.
Sarah Prattley– Clinical Fellow, University Hospital Southamtpn, Southampton, England, United Kingdom
Rachel Oliver– Specialty Registrar, Salisbury Hospital, London, England, United Kingdom
Francesca New– Specialty Registrar, Salisbury, Salisbury, England, United Kingdom
Melissa Davies– Consultant Urologist, Salisbury, Salisbury, England, United Kingdom
James Brewin– Consultant Urologist, Salisbury Hospital, Salisbury, England, United Kingdom
University Hospital Southamtpn
Southampton, England, United Kingdom