Bilateral extracorporeal shock wave lithotripsy in a spinal cord injury patient with a cardiac pacemaker

Chapitre A-3 - Lithiase du haut appareil et vessie neurologique: spécificités thérapeutiques

Upper tract stones are a frequent complication in neurourology and require specific treatment according to modalities adapted to the clinical setting. All modern treatment modalities for stones can be proposed: extracorporeal lithotripsy (ESWL), percutaneous nephrolithotomy and open surgery depending on the local conditions. The treatment objectives in the neurologically disabled population must be to combine a maximum of fragmentation and elimination in the same treatment session. ESWL therefore has a more limited place in this population. On the other hand, a renal stone measuring 1.5 cm must be treated by percutaneous surgery. Finally, management of upper tract stones depends on evaluation and stabilization of the lower tract (pressures, urinary tract infection, residual urine) to decrease the risk of recurrent stones.

Urolithiasis in patients with spinal cord injuries: risk factors, management, and outcomes

PURPOSE OF REVIEW

Despite major advances in the urological care of spinal cord injury patients, the incidence of urolithiasis has not changed. Although the incidence of kidneys lost to staghorn calculus disease has decreased considerably, stone disease is still a significant cause of morbidity and concern. The purpose of this review is to summarize the risk factors for the development of stone diseases in the spinal cord injury patient population and present the outcomes of current endourologic treatment modalities.

RECENT FINDINGS

Recurrent urinary tract infections, indwelling catheters, vesicoureteral reflux, and immobilization hypercalcuria are a few of the major risk factors for the development of urolithiasis among spinal cord injury patients. Retrograde endourologic techniques are often not possible to address stone disease due to lower extremity contractures, spinal curvature, and pelvic tilt. Extracorporeal shockwave lithotripsy success rates vary from 50 to 90%, but clearance rates are often delayed. Success rates for percutaneous nephrolithotomy match those quoted in the general population ( > 90%), but at the expense of a higher rate of complications (6-20%). Meticulous planning with regard to appropriate prophylactic antibiotics and body position will maximize efficacious outcomes.

SUMMARY

Early identification and treatment of urolithiasis in spinal cord injury patients will aid in preserving renal function and minimizing associated complications. Despite variation in common urological practices between spinal cord injury units and the lack of clear cut guidelines for follow-up, the increased incidence of risks associated with urolithiasis lends support for routine genitourinary imaging in order to identify and treat those individuals at highest risk.