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Bødker C, Riisbøl MF, Khan BYA, Hansen RM, Severinsen KE. Urologic surveillance of persons with spinal cord injuries - a scoping review. Spinal Cord 2024; 62:91-98. [PMID: 38182679 DOI: 10.1038/s41393-023-00955-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 01/07/2024]
Abstract
STUDY DESIGN Scoping review - standardized according to the Equator-network and the Prisma-Statement guidelines with PRISMA-ScR. OBJECTIVES Review the literature concerning surveillance of the urinary- and renal systems in persons with spinal cord injuries (SCI). Specifically, to assess: #1 the usability of non-invasive and non-ultrasound methods, #2 the usage of systematic ultrasound surveillance #3 patient characteristics which predispose to urinary tract abnormalities (UTA) or renal function deterioration. METHODS The literature assessed was collected from PubMed by creating a search string comprised of three main phrases: #1 persons with SCI, #2 kidney function and #3 surveillance program. The final search resulted in 685 studies. Eligibility criteria were defined prior to the search to assess the studies systematically. RESULTS Four studies found serum cystatin C (s-cysC) to be accurate in estimating the glomerular filtration rate in persons with SCI. One study found no difference in UTA between surveillance adherent and surveillance non-adherent persons up to 30 years post injury. UTA and especially renal function deterioration seems rare the first 15 years post-injury. Non-traumatic SCI, time since injury, high detrusor pressure, upper urinary tract dilation, vesicourethral reflux, trabeculated bladder, history of calculi removal are significant risk factors for developing UTA or renal function deterioration. CONCLUSION Measurements of S-cysC should be considered to replace serum creatinine in most cases. Surveillance non-adherent persons are not at higher risk of developing UTA. A selective surveillance based on a baseline risk profile may be beneficial for patients and caretakers.
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Affiliation(s)
| | - Maja F Riisbøl
- Spinal Cord Injury Center of Western Denmark, Viborg, Denmark
| | | | - Rikke M Hansen
- Spinal Cord Injury Center of Western Denmark, Viborg, Denmark
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Kim J, Stewart V, Talwar G, Uy M, Hoogenes J, Matsumoto ED. A systematic review of postoperative outcomes of kidney stone surgery and meta-analysis of outcomes of percutaneous nephrolithotomy in individuals with spinal cord injury. Spinal Cord 2023; 61:469-476. [PMID: 37596394 DOI: 10.1038/s41393-023-00927-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 07/28/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES To evaluate outcomes of surgical treatment for nephrolithiasis in individuals with spinal cord injury (SCI). METHODS We systematically reviewed the Ovid MEDLINE, Embase, CENTRAL, and Web of Science databases for studies examining outcomes of kidney stone procedures in individuals with SCI. Our primary outcomes were stone-free rate (SFR) and complications as categorized by Clavien-Dindo classification. A meta-analysis of comparative studies was performed to assess differences in SFR and complication rate between individuals with and without SCI following PCNL. RESULTS A total of 27 retrospective and observational articles were included. Interventions for kidney stones included PCNL, shockwave lithotripsy (SWL), and ureteroscopy. Pooled SFR in individuals with SCI was 54%, for SWL, 74% for PCNL, and 36% for ureteroscopy. Meta-analyses found that there was higher rate of grades I (OR 9.54; 95% CI, 3.06 to 29.79), II (OR 3.38; 95% CI, 1.85 to 6.18), and III-V (OR 2.38; 95% CI, 1.35 to 4.19) complications in individuals with SCI compared to non-SCI individuals following PCNL. The rate of infectious complications was also higher in individuals with SCI (OR 6.15; 95% CI, 1.86 to 20.39). However, there was no difference in SFR (OR 0.64; 95% CI, 0.15 to 2.64) between groups. CONCLUSIONS Individuals with SCI are at higher risk of minor, major, and infectious complications following PCNL compared to non-SCI individuals. There was no significant difference between groups in SFR following PCNL, suggesting that PCNL is an effective surgery for kidney stones in individuals with SCI.
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Affiliation(s)
- John Kim
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada.
| | - Veronica Stewart
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Gaurav Talwar
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Michael Uy
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jen Hoogenes
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
- McMaster Institute of Urology, St. Joseph's Hospital, Hamilton, ON, Canada
| | - Edward D Matsumoto
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
- McMaster Institute of Urology, St. Joseph's Hospital, Hamilton, ON, Canada
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Craven BC, Cirnigliaro CM, Carbone LD, Tsang P, Morse LR. The Pathophysiology, Identification and Management of Fracture Risk, Sublesional Osteoporosis and Fracture among Adults with Spinal Cord Injury. J Pers Med 2023; 13:966. [PMID: 37373955 DOI: 10.3390/jpm13060966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The prevention of lower extremity fractures and fracture-related morbidity and mortality is a critical component of health services for adults living with chronic spinal cord injury (SCI). METHODS Established best practices and guideline recommendations are articulated in recent international consensus documents from the International Society of Clinical Densitometry, the Paralyzed Veterans of America Consortium for Spinal Cord Medicine and the Orthopedic Trauma Association. RESULTS This review is a synthesis of the aforementioned consensus documents, which highlight the pathophysiology of lower extremity bone mineral density (BMD) decline after acute SCI. The role and actions treating clinicians should take to screen, diagnose and initiate the appropriate treatment of established low bone mass/osteoporosis of the hip, distal femur or proximal tibia regions associated with moderate or high fracture risk or diagnose and manage a lower extremity fracture among adults with chronic SCI are articulated. Guidance regarding the prescription of dietary calcium, vitamin D supplements, rehabilitation interventions (passive standing, functional electrical stimulation (FES) or neuromuscular electrical stimulation (NMES)) to modify bone mass and/or anti-resorptive drug therapy (Alendronate, Denosumab, or Zoledronic Acid) is provided. In the event of lower extremity fracture, the need for timely orthopedic consultation for fracture diagnosis and interprofessional care following definitive fracture management to prevent health complications (venous thromboembolism, pressure injury, and autonomic dysreflexia) and rehabilitation interventions to return the individual to his/her pre-fracture functional abilities is emphasized. CONCLUSIONS Interprofessional care teams should use recent consensus publications to drive sustained practice change to mitigate fracture incidence and fracture-related morbidity and mortality among adults with chronic SCI.
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Affiliation(s)
- Beverley Catharine Craven
- KITE Research Institute, 520 Sutherland Dr, Toronto, ON M4G 3V9, Canada
- Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, ON M5S 1A8, Canada
| | - Christopher M Cirnigliaro
- Department of Veterans Affairs Rehabilitation, Research, and Development Service, Spinal Cord Damage Research Center, Bronx, NY 10468, USA
| | - Laura D Carbone
- Department of Medicine: Rheumatology, Medical College of Georgia, Augusta University, 1120 15th St, Augusta, GA 30912, USA
| | - Philemon Tsang
- KITE Research Institute, 520 Sutherland Dr, Toronto, ON M4G 3V9, Canada
| | - Leslie R Morse
- Department of Rehabilitation Medicine, University of Minnesota, 500 Harvard St SE, Minneapolis, MN 55455, USA
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Wu SY, Jhang JF, Liu HH, Chen JT, Li JR, Chiu B, Chen SL, Kuo HC. Long-Term Surveillance and Management of Urological Complications in Chronic Spinal Cord-Injured Patients. J Clin Med 2022; 11:7307. [PMID: 36555924 PMCID: PMC9785560 DOI: 10.3390/jcm11247307] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
Bladder dysfunction is a common complication after chronic spinal cord injury (SCI). Patients may experience renal function loss, urinary tract infection (UTI), urolithiasis, bladder cancer, and even life-threatening events such as severe sepsis or renal failure. Suitable patient care may prevent UTI and urinary incontinence, decrease medication use, and preserve renal function. As the primary goal is to preserve renal function, management should be focused on facilitating bladder drainage, the avoidance of UTI, and the maintenance of a low intravesical pressure for continence and complete bladder emptying. Currently, several bladder management options are available to SCI patients: (1) reflex voiding; (2) clean intermittent catheterization; (3) indwelling catheterization. The target organ may be the bladder or the bladder outlet. The purposes of intervention include the following: (1) increasing bladder capacity and/or decreasing intravesical pressure; (2) increasing bladder outlet resistance; (3) decreasing bladder outlet resistance; (4) producing detrusor contractility; (5) urinary diversion. Different bladder management methods and interventions may have different results depending on the patient's lower urinary tract dysfunction. This review aims to report the current management options for long-term bladder dysfunction in chronic SCI patients. Furthermore, we summarize the most suitable care plans for improving the clinical outcome of SCI patients.
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Affiliation(s)
- Shu-Yu Wu
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan
- Department of Urology, School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Jia-Fong Jhang
- Department of Urology, School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan
| | - Hsin-Ho Liu
- Department of Urology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 42743, Taiwan
| | - Jian-Ting Chen
- Division of Urology, Department of Surgery, Yuanlin Christian Hospital, Changhua 51053, Taiwan
| | - Jian-Ri Li
- Department of Urology, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Bin Chiu
- Department of Urology, Far Eastern Memorial Hospital, New Taipei City 22000, Taiwan
| | - Sung-Lang Chen
- Department of Urology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Department of Urology, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan
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Urinary system complications and long-term treatment compliance in chronic traumatic spinal cord injury patients with neurogenic lower urinary tract dysfunction. Turk J Phys Med Rehabil 2022; 68:278-285. [PMID: 35989971 PMCID: PMC9366489 DOI: 10.5606/tftrd.2022.7719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 07/29/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives
The aim of this study was to evaluate upper and lower urinary tract complications and the compliance of long-term treatment in patients with spinal cord injury (SCI) by urodynamic examination.
Patients and methods
Between January 1997 and May 2007, a total of 89 patients with SCI (79 males, 19 females; mean age: 39.8±12.2 years; range, 19 to 72 years) who were admitted to physical medicine and rehabilitation clinic were retrospectively analyzed. Demographic, neurological, and urodynamic data of the patients with the diagnosis of neurogenic lower urinary tract dysfunction (NLUTD) in their initial urodynamic examination and without regular follow-up were recorded.
Results
The mean time to the first urodynamic examination was 8.6±5.4 months. Sixty-seven patients who had neurogenic detrusor overactivity (NDO) in their first urodynamic tests were recommended anticholinergics. Clean intermittent catheterization (CIC) was recommended after initial urodynamic examination in all patients. Thirty-nine patients of 67 who had NDO were taking medications, while 28 were not. In the patients who continued anticholinergic treatment, bladder capacity was found to statistically significantly increase, compared to the initial measurement values and detrusor pressures significantly decreased (p<0.001). The compliance rate with CIC and anticholinergic treatment was 79.8% and 58.2%, respectively. Sixteen of the patients had calculus in the urinary system. Forty-two patients had infections more than once a year and used antibiotics.
Conclusion
Neurogenic bladder should be evaluated at the beginning of SCI and, then, followed on a regular basis. Urodynamic tests should be performed immediately after spinal shock and can be repeated, as indicated.
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Assessment of Bacterial Communities Within the Biofilm of Bladder Calculi in the Neurogenic Bladder Rat Model Following Spinal Cord Injury. Int Neurourol J 2022; 26:26-30. [PMID: 35368183 PMCID: PMC8984690 DOI: 10.5213/inj.2142182.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/26/2021] [Indexed: 11/08/2022] Open
Abstract
Purpose: To develop a rat model of bladder calculi in the neurogenic bladder following spinal cord injury (SCI) and assess bacterial communities within the biofilm of bladder calculi using denaturing gradient gel electrophoresis (DGGE).Methods: The silk tied to a small segment of the Teflon IV catheter was implanted through the urethra into the bladder of rats with SCI induced by T9 laminectomy. After 6 months, the rats were sacrificed and their bladder calculi were collected by opening the bladders through the low-midline incision. Genomic DNA was extracted from the biofilm of bladder calculi followed by DGGE to obtain bacterial DNA. The DNA sequences were compared and analyzed using BLAST (Basic Local Alignment Search Tool) to identify bacteria.Results: After placing silk nidus in the bladder for 6 months, all 6 rats developed bladder calculi. According to DGGE analysis, Pseudomonas aeruginosa was the most dominant strain, while Clostridium sp. and Lactobacillus sp. were relatively dominant strains within the biofilm of bladder calculi in the rats with SCI.Conclusions: DGGE analysis showed various microorganisms in the biofilm of calculi arising from a neurogenic bladder rat model. This research design can be the basis for clinical studies and may be applied to calculi in patients with neurogenic bladder following SCI.
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Zeelenberg AM, Hendriks N, Schout BMA, van der Spruit JA. Case report. Geschokt door de wachttijd: ESWL bij blaasstenen. TIJDSCHRIFT VOOR UROLOGIE 2022. [PMCID: PMC8500464 DOI: 10.1007/s13629-021-00341-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
SamenvattingDe behandeling van eerste keuze voor vesicale stenen is de transurethrale cystolithotripsie (TUCL). Door de COVID-19-pandemie kampen ziekenhuizen echter met lange wachttijden voor – onder meer – deze operaties. Daarnaast komen sommige patiënten niet in aanmerking voor een operatie door hun comorbiditeit. In de jaren negentig van de vorige eeuw was extracorporele shockwave lithotripsie (ESWL) een veel gebruikte, veilige behandelmethode voor blaasstenen. Toen TUCL effectiever bleek, is ESWL voor blaasstenen echter in de vergetelheid geraakt. ESWL is poliklinisch uit te voeren, waardoor wachttijden korter zijn dan die voor operatieve ingrepen. Gedurende de COVID-19-pandemie hebben we enkele patiënten met blaasstenen behandeld met ESWL. We concluderen dat ESWL een geschikt alternatief is voor de TUCL bij geselecteerde patiënten, maar dat voor een effectieve behandeling meerdere ESWL-procedures nodig zijn.
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Policy analysis on power standing systems. Prev Med Rep 2021; 24:101601. [PMID: 34976658 PMCID: PMC8683940 DOI: 10.1016/j.pmedr.2021.101601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 10/06/2021] [Accepted: 10/09/2021] [Indexed: 11/27/2022] Open
Abstract
Power wheelchairs provide people with mobility disabilities opportunities for independence in mobility and repositioning themselves. However, current power wheelchair power options covered by Medicare limit the person to a horizontal plane. In the home, access to the vertical plane is also required for mobility related activities of daily living. Power standing systems on power wheelchairs are one option for providing access to the vertical environment, although currently these systems are not covered by Medicare. Power standing systems also aid in medical management and in preventing common comorbidities associated with chronic neurological and congenital healthcare conditions. Therefore, a legal group led an interdisciplinary effort to change Medicare policy on power standing systems. A policy analysis using Bardach’s Eightfold policy framework was conducted to analyze a clinical groups’ action within this interdisciplinary team. The clinical team considered three viable options to address the problem and evaluated these options against five criteria. Ultimately, a national coverage determination reconsideration would provide a needed opportunity for the coverage of power standing systems. Suggested coverage criteria for power standing systems, based on existing literature and expert clinical experience, are proposed.
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Taha DE, Raheem AA, Aljarbou A, Bahdilh S, Alrubat A, Alowidah I. A large renal bullet that resembles a large renal stone. A rare case scenario. Int J Surg Case Rep 2021; 85:106180. [PMID: 34304086 PMCID: PMC8327656 DOI: 10.1016/j.ijscr.2021.106180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Genitourinary trauma secondary to a gunshot wound is uncommon as it only occurs in about 10% of cases. We present a case of a gentleman who suffered a gunshot wound to the kidney. Presentation of case A 28 year old man presented with irritative lower urinary tract symptoms (LUTs) since three months. The medical history was irrelevant. He is known case of neurogenic bladder maintained on regular clean intermittent catheterization (CIC). He has history of gunshot to the back since few years that resulted in spinal injury. CTUT showed retained bullet inside the right kidney that look alike hyperdense renal stone, Moreover, multiple vesical stones. The vesical stones were treated with cystolitholapaxy. Given that the patient is asymptomatic, conservative management for the retained right renal bullet is the feasible option. Discussion Based on the ASST classification, renal gunshot injury results in a grade IV injury. Abdominal exploration was reserved only in selected scenarios. Gunshot injuries to the kidney are commonly associated with thoracic and abdominal injuries. Gunshot injuries may be caused by low-velocity or high-velocity bullets. Given the paucity of cases reported in the literature, it is not obvious what is the optimum management of such patients with a retained renal bullet? We present the radiological findings and a clinical case summary as well for those who have Grade IV kidney injury and retained bullet managed conservatively. Conclusion Retained renal bullet post gunshot injury to the back is unusual presentation. A characteristic star-like pattern produced by lead shots and not by “stone,” consisting of plastic detonating cap will aid the urologist to differentiate retained renal bullet from renal stone. In such scenario, asymptomatic renal bullet look alike renal stone doesn't necessitate treatment.
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Affiliation(s)
- Diaa-Eldin Taha
- Urology Department, King Saud Medical City, Riyadh, Saudi Arabia; Urology department, Kafrelsheikh University, Egypt.
| | - Ali Abdel Raheem
- Urology Department, King Saud Medical City, Riyadh, Saudi Arabia; Urology Department, College of Medicine, Tanta University, Tanta, Egypt
| | | | - Salem Bahdilh
- Urology Department, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Ibrahim Alowidah
- Urology Department, King Saud Medical City, Riyadh, Saudi Arabia
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Wang W, Fang H, Xie P, Cao Q, He L, Cai W. Create a predictive model for neurogenic bladder patients: upper urinary tract damage predictive nomogram. Int J Neurosci 2019; 129:1240-1246. [PMID: 31401918 DOI: 10.1080/00207454.2019.1655016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: To create a nomogram to evaluate the risk of upper urinary tract damage (UUTD) in patients with neurogenic bladder (NGB) Methods: A retrospective analysis was conducted on 301 patients with NGB who were admitted to certain hospitals. Data collected included clinical symptoms, patients' characteristics, laboratory parameters, imaging findings, and urodynamic parameters. The least absolute shrinkage and selection operator(LASSO)regression model was used to optimise the selection of predictors. Multivariate logistic regression analysis was performed to develop a UUTD risk predictive model. Validation was performed by bootstrap. Results: The predictors included in the nomogram included sex, duration of disease, history of UTI, bladder compliance, and fecal incontinence. The model presented good discrimination with a C-index value of 0.796 (95% confidence interval: 0.74896-0.84304) and good calibration. The C-index value of the interval validation was 0.7872112. The results of decision curve analysis (DCA) demonstrated that the UUTD-risk predictive nomogram was clinically useful. Conclusion: The nomogram incorporating the sex, duration of disease, history of UTI, bladder compliance, and fecal incontinence could be an important tool of UUTD risk prediction in NGB patients.
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Affiliation(s)
- Wenqiang Wang
- Department of Nursing, Shenzhen Hospital, Southern Medical University , Shenzhen , China
| | - Hengying Fang
- Department of Nursing, The Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Peng Xie
- Department of Critical Care Medicine, Nanchong Central Hospital, the Second Clinical Medical College of North Sichuan Medical College , Nanchong , China
| | - Qunduo Cao
- Department of Urology, Peking University Shenzhen Hospital , Shenzhen , China
| | - Ling He
- Department of Radiation Oncology Department, Nanfang Hospital, Southern Medical University, Guangzhou , China
| | - Wenzhi Cai
- Department of Nursing, Shenzhen Hospital, Southern Medical University , Shenzhen , China
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Lane GI, Roberts WW, Mann R, O'Dell D, Stoffel JT, Clemens JQ, Cameron AP. Outcomes of renal calculi in patients with spinal cord injury. Neurourol Urodyn 2019; 38:1901-1906. [DOI: 10.1002/nau.24091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/17/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Giulia I. Lane
- Department of UrologyUniversity of Michigan Ann Arbor Michigan
| | | | - Rachel Mann
- Department of UrologyUniversity of Minnesota Minneapolis Minnesota
| | - Diana O'Dell
- Department of UrologyUniversity of Michigan Ann Arbor Michigan
| | - John T. Stoffel
- Department of UrologyUniversity of Michigan Ann Arbor Michigan
| | | | - Anne P. Cameron
- Department of UrologyUniversity of Michigan Ann Arbor Michigan
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Nally E, Groah SL, Pérez-Losada M, Caldovic L, Ljungberg I, Chandel NJ, Sprague B, Hsieh MH, Pohl HG. Identification of Burkholderia fungorum in the urine of an individual with spinal cord injury and augmentation cystoplasty using 16S sequencing: copathogen or innocent bystander? Spinal Cord Ser Cases 2018; 4:85. [PMID: 30275977 PMCID: PMC6155001 DOI: 10.1038/s41394-018-0115-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/30/2018] [Accepted: 08/01/2018] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION People with neuropathic bladder (NB) secondary to spinal cord injury (SCI) are at risk for multiple genitourinary complications, the most frequent of which is urinary tract infection (UTI). Despite the high frequency with which UTI occurs, our understanding of the role of urinary microbes in health and disease is limited. In this paper, we present the first prospective case study integrating symptom reporting, urinalysis, urine cultivation, and 16S ribosomal ribonucleic acid (rRNA) sequencing of the urine microbiome. CASE PRESENTATION A 55-year-old male with NB secondary to SCI contributed 12 urine samples over an 8-month period during asymptomatic, symptomatic, and postantibiotic periods. All bacteria identified on culture were present on 16S rRNA sequencing, however, 16S rRNA sequencing revealed the presence of bacteria not isolated on culture. In particular, Burkholderia fungorum was present in three samples during both asymptomatic and symptomatic periods. White blood cells of ≥5-10/high power field and leukocyte esterase ≥2 on urinalysis was associated with the presence of symptoms. DISCUSSION In this patient, there was a predominance of pathogenic bacteria and a lack of putative probiotic bacteria during both symptomatic and asymptomatic states. Urinalysis-defined inflammatory markers were present to a greater extent during symptomatic periods compared to the asymptomatic state, which may underscore a role for urinalysis or other inflammatory markers in differentiating asymptomatic bacteriuria from UTI in patients with NB. The finding of potentially pathogenic bacteria identified by sequencing but not cultivation, suggests a need for greater understanding of the relationships amongst bacterial species in the bacteriuric neuropathic bladder.
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Affiliation(s)
- Emma Nally
- MedStar National Rehabilitation Hospital, 102 Irving St., NW, Washington, DC 20010 USA
- Department of Rehabilitation Medicine, MedStar Georgetown University Hospital, Washington, DC USA
| | - Suzanne L. Groah
- MedStar National Rehabilitation Hospital, 102 Irving St., NW, Washington, DC 20010 USA
- Department of Rehabilitation Medicine, MedStar Georgetown University Hospital, Washington, DC USA
| | - Marcos Pérez-Losada
- Computational Biology Institute, The George Washington University, Ashburn, VA USA
- Department of Integrative Systems Biology, Children’s National Health System, Washington, DC USA
- CIBIO-InBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, , Universidade do Porto, 4485-661 Vairão Porto, Portugal
| | - Ljubica Caldovic
- Department of Integrative Systems Biology, Children’s National Health System, Washington, DC USA
| | - Inger Ljungberg
- MedStar National Rehabilitation Hospital, 102 Irving St., NW, Washington, DC 20010 USA
| | - Neel J. Chandel
- Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY USA
| | - Bruce Sprague
- Division of Urology, Children’s National Health System, Washington, DC USA
| | - Michael H. Hsieh
- Division of Urology, Children’s National Health System, Washington, DC USA
| | - Hans G. Pohl
- Division of Urology, Children’s National Health System, Washington, DC USA
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Morhardt DR, Hadj-Moussa M, Chang H, Wolf JS, Roberts WW, Stoffel JT, Faerber GJ, Cameron AP. Outcomes of Ureteroscopic Stone Treatment in Patients With Spinal Cord Injury. Urology 2018; 116:41-46. [PMID: 29545043 DOI: 10.1016/j.urology.2018.01.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/10/2018] [Accepted: 01/18/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the association of clinical factors on outcomes in patients with spinal cord injury (SCI) undergoing ureteroscopy. Immobility, recurrent urinary tract infection, and lower urinary tract dysfunction contribute to renal stone formation in patients with SCI. Ureteroscopy is a commonly utilized treatment modality; however, surgical complication rates and outcomes have been poorly defined. Evidence guiding safe and effective treatment of stones in this cohort remains scarce. METHODS Records were retrospectively reviewed for patients with SCI who underwent ureteroscopy for kidney stones from 1996 to 2014 at a single institution. Multivariate relationships were evaluated using a general estimating equation model. RESULTS Forty-six patients with SCI underwent a total of 95 ureteroscopic procedures. After treatment, stone-free rate was 17% and 20% with <2-mm fragments. The complication rate was 21%. On multivariate analysis, SCI in cervical (C) levels was associated with higher risk of complications (C3: odds ratio [OR] 3.83, 95% confidence interval [CI] 2.17-6.98; C6: OR 3.83, 95% CI 1.08-13.53). American Spinal Injury Association Scale A classification was associated with a lower probability of stone-free status (OR 0.16, 95% CI 0.03-0.82). Patients averaged 2.2 procedures yet more procedures were associated with lower stone-free status (OR 0.83, 95% CI 0.03-0.32). Chronic obstructive pulmonary disease and bladder management modality were not associated with stone-free status or complications. CONCLUSION In patients with SCI, higher injury level and complete SCI were associated with worse stone clearance and more complications. Stone-free rate was 17%. Overall, flexible ureteroscopy is a relatively safe procedure in this population. Alternative strategies should be considered after failed ureteroscopy.
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Affiliation(s)
| | | | - He Chang
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - J Stuart Wolf
- Department of Urology, University of Michigan, Ann Arbor, MI
| | | | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Gary J Faerber
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Anne P Cameron
- Department of Urology, University of Michigan, Ann Arbor, MI
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Stauffer CE, Snyder E, Ngo TC, Elliott CS. Is Neurogenic Bladder a Risk Factor for Febrile Urinary Tract Infection After Ureteroscopy and, if so, Why? Urology 2017; 112:33-37. [PMID: 29056577 DOI: 10.1016/j.urology.2017.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/03/2017] [Accepted: 10/05/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To characterize the rate of febrile urinary tract infections (UTIs) after ureteroscopy in patients with neurogenic bladder compared with those with physiologically normal bladders. Although generally considered safe and effective, there is a growing body of evidence suggesting that patients with neurogenic bladder are at an increased risk of infectious complications following ureteroscopy. METHODS We performed a retrospective chart review of those undergoing ureteroscopy in a single academically affiliated hospital system between June 2013 and May 2016. Information regarding neurogenic bladder status, culture results, bladder management, and the presence of upper tract decompression was collected. Postoperative febrile UTI was defined as a hospital admission within 1 week of surgery because of fever not attributable to another source. RESULTS Of 467 ureteroscopies, 44 (9.5%) were performed in the setting of neurogenic bladder. Febrile UTI rates were higher in patients with neurogenic bladder compared with control patients (9% vs 1.4%, P = .01) with significantly higher rates in those dependent on bladder catheterization. Interestingly, the presence of a nephrostomy tube in patients with physiologically normal bladders increased the risk of postoperative febrile UTI to levels comparable with patients with neurogenic bladder who were catheter dependent (10.5% vs 12.5%, respectively). CONCLUSION Although infectious complications in the neurogenic population are likely multifactorial, the reliance on catheterization and thus colonization appears to be a significant factor and extends to non-neurogenic patients. These data suggest that bacterial colonization may be the significant underlying risk factor for febrile UTI after ureteroscopy.
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Affiliation(s)
| | | | - Tin C Ngo
- Department of Urology, Stanford University, Palo Alto, CA
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15
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Böthig R, Domurath B, Kaufmann A, Bremer J, Vance W, Kurze I. [Neuro-urological diagnosis and therapy of lower urinary tract dysfunction in patients with spinal cord injury : S2k Guideline of the German-Speaking Medical Society of Paraplegia (DMGP), AWMF register no. 179/001]. Urologe A 2017; 56:785-792. [PMID: 28314966 DOI: 10.1007/s00120-017-0354-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Most patients with spinal cord injury (SCI) suffer from neurogenic lower urinary tract dysfunction (NLUTD), bowel dysfunction and sexual dysfunction. If these remain untreated, severe medical complications and serious limitations (restrictions) in quality of life are imminent. OBJECTIVES In the long term, there are considerable differences in the treatment results of highly specialized centers versus other treatment facilities. MATERIALS AND METHODS Against this background, a consensus-based guideline, according to the AWMF (Association of the Scientific Medical Societies in Germany) criteria (S2k), was developed by the neuro-urology working group of the DMPG (German-Speaking Medical Society of Paraplegia). RESULTS The guideline defines the principles and objectives of the neuro-urological care of patients with SCI and discusses in detail the principles of diagnosis and therapy of NLUTD. The need for video-urodynamic studies as a basis for the classification of the NLUTD and as a foundation for the development of a treatment strategy is emphasized. Both conservative and surgical therapy options and their indications are explained in detail. Possible complications and their prevention in the long-term course of SCI are presented with a particular consideration of the specific features of urinary tract infections and autonomic dysreflexia. Finally, the principles of the provision of urological appliances are discussed. CONCLUSIONS The presented S2k guideline provides the current standards in the neuro-urological care of patients with NLUTD due to SCI. Their consistent implementation both in the acute and chronic phase as well as in the context of lifelong surveillance of SCI patients should prevent the impending complications of NLUTD.
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Affiliation(s)
- R Böthig
- Abt. Neuro-Urologie, Querschnittgelähmtenzentrum, BG-Klinikum Hamburg, Bergedorfer Str. 10, 21033, Hamburg, Deutschland.
| | - B Domurath
- Neurologische Rehabilitationsklinik, Neuro-Urologisches Zentrum, Kliniken Beelitz GmbH, Paracelsusring 6a, 14547, Beelitz-Heilstätten, Deutschland
| | - A Kaufmann
- Zentrum für Kontinenz und Neuro-Urologie, Kliniken Maria Hilf GmbH, Viersener Str. 450, 41063, Mönchengladbach, Deutschland
| | - J Bremer
- Zentrum für Neuro-Rehabilitation, Querschnittgelähmten-Zentrum, BDH-Klinik Greifswald gGmbH, Karl-Liebknecht-Ring 26a, 17491, Greifswald, Deutschland
| | - W Vance
- Neurologische Rehabilitationsklinik, Neuro-Urologisches Zentrum, Kliniken Beelitz GmbH, Paracelsusring 6a, 14547, Beelitz-Heilstätten, Deutschland
| | - I Kurze
- Querschnittgelähmten-Zentrum, Klinik für Paraplegiologie und Neuro-Urologie, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437, Bad Berka, Deutschland
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Ganesan V, Chen WM, Jain R, De S, Monga M. Multiple sclerosis and nephrolithiasis: a matched-case comparative study. BJU Int 2017; 119:919-925. [DOI: 10.1111/bju.13820] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Vishnu Ganesan
- Cleveland Clinic Lerner College of Medicine; Cleveland OH USA
| | - Wen Min Chen
- Case Western Reserve University School of Medicine; Cleveland OH USA
| | - Rajat Jain
- Cleveland Clinic Glickman Urological Kidney Institute; Cleveland OH USA
| | - Shubha De
- Cleveland Clinic Glickman Urological Kidney Institute; Cleveland OH USA
| | - Manoj Monga
- Cleveland Clinic Glickman Urological Kidney Institute; Cleveland OH USA
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17
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Outcomes of percutaneous nephrolithotomy in spinal cord injury patients as compared to a matched cohort. Urolithiasis 2016; 45:501-506. [DOI: 10.1007/s00240-016-0958-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
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Flexible ureteroscopic laser lithotripsy for upper urinary tract stone disease in patients with spinal cord injury. Urolithiasis 2015; 43:501-5. [PMID: 25987450 DOI: 10.1007/s00240-015-0786-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
Abstract
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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Danawala ZA, Singh D. Paraplegia-quadriplegia Independently Increases All Percutaneous Nephrolithotomy Complications: A Comparative Study Using the Modified Clavien System. Urology 2015; 85:1007-1014. [DOI: 10.1016/j.urology.2014.11.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 11/08/2014] [Accepted: 11/22/2014] [Indexed: 10/23/2022]
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Schurch B, Tawadros C, Carda S. Dysfunction of lower urinary tract in patients with spinal cord injury. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:247-67. [PMID: 26003248 DOI: 10.1016/b978-0-444-63247-0.00014-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Over the past 50 years, the mortality for urorenal cause in patients with spinal cord injuries (SCI) has decreased from over 75% to 2.3%, as a result of dramatic improvements in the diagnosis and management of lower urinary tract dysfunction (LUTD). The aims of this chapter are to assess the physiopathology of upper and lower motor neuron lesion on bladder and sphincter function after SCI, to give an overview of required clinical and instrumental examination and to discuss treatment modalities. Videourodynamic examination plays a key role in the assessment and follow-up of LUTD in SCI patients, in conjunction with neurophysiological and radiological examinations. The cornerstone of bladder management in SCI is clean intermittent self-catheterization, but often other treatments are needed to achieve full continence, to reduce infections and stone formation, to protect the upper urinary tract from excessive bladder pressure, and to prevent chronic renal failure. Treatments may be pharmacologic (i.e., anticholinergic drugs and botulinum toxin) or surgical (by enterocystoplasty or urinary diversion). In selected cases, neuromodulation and sacral root stimulation can be used to reduce detrusor overactivity and empty the bladder. Management of LUTD in SCI patients requires a deep knowledge of spinal cord medicine and functioning of patients with neurologic disability.
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Affiliation(s)
- Brigitte Schurch
- Neuropsychology and Neurorehabilitation Service, Department of Clinical Neuroscience, Lausanne University Hospital, Lausanne, Switzerland.
| | - Cécile Tawadros
- Urology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Stefano Carda
- Neuropsychology and Neurorehabilitation Service, Department of Clinical Neuroscience, Lausanne University Hospital, Lausanne, Switzerland
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Nabbout P, Slobodov G, Culkin DJ. Surgical management of urolithiasis in spinal cord injury patients. Curr Urol Rep 2014; 15:408. [PMID: 24740271 DOI: 10.1007/s11934-014-0408-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Urolithiasis is a common condition in patients with spinal cord injury (SCI). Surgical management of stones in this population is more challenging and associated with lower clearance rates than the general population. The rate of complications - specifically infectious complications - is also high due to the chronic bacterial colonization. Shock wave lithotripsy (SWL) has a low clearance rate of 44-73 %. Percutaneous nephrolithotripsy is indicated for larger nephrolithiasis, but multiple procedures may be required to clear the stones. Ureteroscopy has been associated with low success rates because of difficulty in obtaining ureteral access. Historically, bladder stones were managed with open surgery or SWL. Recently, good results have been reported with the combination of endoscopic and laparoscopic techniques. Surgical management of urolithiasis in patients with SCI should be performed in high-volume centers in light of the technical challenges and higher rate of perioperative complications.
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Affiliation(s)
- Philippe Nabbout
- University of Oklahoma Health Sciences Center, 920 Stanton L. Young Blvd, WP 3150, Oklahoma City, OK, 73104, USA,
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22
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The change in upper tract urolithiasis composition, surgical treatments and outcomes of para and quadriplegic patients over time. Urolithiasis 2014; 42:415-9. [PMID: 25015593 DOI: 10.1007/s00240-014-0681-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 06/23/2014] [Indexed: 10/25/2022]
Abstract
Stone disease in patients with spinal cord injury is a source of morbidity and mortality. Previous studies have indicated a decrease in infection-based urolithiasis in recent decades. We aimed to identify changes in stone composition and surgical outcomes in patients with para and quadriplegia over time. A retrospective review of para and quadriplegic patients from 1986 to 2011 who underwent surgical intervention for urolithiasis was performed, identifying 95 patients. The Mantel-Haenszel Chi square test was used to compare change in stone composition over time. The mean patient age was 44.0 years (range 18-88) and treatment included percutaneous nephrolithotomy (PCNL) 40 (42.1 %), ureteroscopy 28 (29.5 %), shock wave lithotripsy (SWL) 26 (27.4 %), and nephrectomy 1 (1 %). Overall stone-free status was found in 47.4 % with 19.0 % requiring a repeat procedure. The median hospital stay for patients undergoing SWL was 2.5 days, ureteroscopy 5 days, and PCNL 6 days. Infection-based stone composition was identified in 23 patients (36.5 %). We evaluated the linear change in percent of each stone component over time and identified increasing components of calcium oxalate dihydrate (p = 0.002) and calcium carbonate (p = 0.009). However, over a period of 25 years, the incidence of infection-based stone did not change (p = 0.57). Para and quadriplegic patients with urolithiasis can be difficult to treat surgically with prolonged hospitalizations, low stone-free status, and often require additional procedures. Despite improvements in antibiotic agents and management of neurogenic bladders, infection-based calculi continue to be a significant source of morbidity to this patient population.
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Ramachandra P, Palazzi KL, Holmes NM, Chiang G. Children with spinal abnormalities have an increased health burden from upper tract urolithiasis. Urology 2014; 83:1378-82. [PMID: 24703461 DOI: 10.1016/j.urology.2013.12.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/17/2013] [Accepted: 12/26/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the epidemiology and health care burden of upper tract urolithiasis in children with spinal abnormalities using a large, national database. Children with spinal dysraphism are predisposed to urolithiasis for many reasons, including immobility, bacteriuria, and urinary stasis. No large epidemiologic studies exist regarding stones in this specific group. Isolated spinal curvature may lead to hypercalciuria from immobility; however, urolithiasis rates are unknown. METHODS We extracted data from the Pediatric Health Information Systems database over an 8-year period. Hospitals reporting inpatient visits, emergency room visits, and ambulatory surgery visits were included. Using International Classification of Diseases, Ninth Revision codes and Current Procedural Terminology codes, we identified children with upper tract urolithiasis, spinal dysraphism, and spinal curvature. Data regarding demographics, prevalence, surgical procedures, costs related to stone procedures were extracted. RESULTS A total of 11,987 patients had urolithiasis. Prevalence of stones in patients with normal spines was 0.24% compared with 1.40% and 4.03% among children with spinal curvature and spinal dysraphism, respectively (P<.001). Children with spinal curvature and spinal dysraphism were more likely to have multiple procedures for stones than those without spinal abnormalities (25% vs 25.7% vs 13.1%, P<.001). Costs per patient were significantly higher for children with spinal abnormalities compared with those with normal spines. CONCLUSION Children with spinal curvature and spinal dysraphism have a much greater rate of upper tract urolithiasis, resulting in more procedures and related costs. Urolithiasis represents a significant, chronic health burden for children with spinal abnormalities. Screening and preventive care may reduce the impact of urolithiasis in these patients.
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Affiliation(s)
- Puneeta Ramachandra
- Division of Pediatric Urology, Children's Hospital Central California, Madera, CA.
| | - Kerrin L Palazzi
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA
| | - Nicholas M Holmes
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA; Department of Pediatric Urology, Rady Children's Hospital San Diego, San Diego, CA
| | - George Chiang
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA; Department of Pediatric Urology, Rady Children's Hospital San Diego, San Diego, CA
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Development of upper tract stones in patients with congenital neurogenic bladder. J Pediatr Urol 2014; 10:112-7. [PMID: 23932553 PMCID: PMC3972384 DOI: 10.1016/j.jpurol.2013.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 07/18/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Patients with neurogenic bladder are at increased risk of developing upper tract stones. We hypothesized that patients with lower urinary tract stone disease are at greater risk of developing upper tract stones. METHODS We performed a 10-year retrospective case-control study of patients with neurogenic bladder to determine the association between bladder and upper tract stones. Independent risk factors for upper tract stones were assessed. Cases and controls were matched 1:1. Univariable analysis was performed by Fisher's exact test and the Mann-Whitney U test. Multivariable logistic regression was performed. RESULTS 52 cases and controls were identified. Cases were significantly more likely to be non-ambulatory, have bowel-urinary tract interposition, thoracic level dysraphism, and history of bladder stones. On multivariable analysis, independent predictors of stone formation were male sex (OR 2.82; p = 0.02), dysraphism involving the thoracic spine (OR 3.37; p = 0.014) bowel-urinary tract interposition (OR 2.611; p = 0.038), and a history of bladder stones (OR 3.57; p = 0.015). CONCLUSION Patients with neurogenic bladder are at increased risk for upper tract stones. The presence of bladder stones may herald the development of upper tract stones. The predictors of stone disease identified should guide prospective studies to better understand the natural history of upper tract stone development in this population.
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Bladder stones in patients with spinal cord injury: a long-term study. Spinal Cord 2014; 52:295-7. [PMID: 24469146 DOI: 10.1038/sc.2014.1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 12/20/2013] [Accepted: 01/03/2014] [Indexed: 12/14/2022]
Abstract
STUDY DESIGN Retrospective follow-up study. OBJECTIVES To assess the occurrence of bladder stones in patients with spinal cord injury (SCI). SETTING Single SCI rehabilitation center in Switzerland. METHODS We searched our database for SCI patients who had undergone surgery due to bladder stones between 2004 and 2012. In all patients retrieved, personal characteristics, bladder management, bladder stone occurrence and time to stone formation/recurrence were recorded. RESULTS We identified 93 (3.3%) of 2825 patients with bladder stones, 24 women and 69 men, with a mean age 50 years (17-83) years. We observed bladder stones in patients with suprapubic catheter (SPC) in 11% (50/453), transurethral catheter (TC) in 6.6% (5/75), with intermittent catheterization (IC) in 2% (27/1315) and with reflex micturition (RM) in 1.1% (11/982), respectively. The mean time period to stone development was 95 months. The TC group had the shortest time interval (31 months), followed by the SPC group (59 months), individuals performing IC (116 months) and RM (211 months), respectively. Bladder stone recurrence rate was 23%. Recurrences were most frequent in the TC group (40%), followed by SPC (28%) and IC (22%), whereas no recurrences occurred in the RM group. Time to recurrence was shortest in the SPC group (14 months), followed by the IC (26 months) and the TC group (31 months), respectively. CONCLUSION In SCI patients, bladder management has an important role in the development of bladder stones. Indwelling catheters (TC/SPC) are associated with the highest risk to develop bladder stones and therefore should be avoided if possible. If unavoidable, SPC are superior to TC.
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26
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The surgical management of upper tract stone disease among spinal cord-injured patients. Spinal Cord 2013; 51:457-60. [DOI: 10.1038/sc.2013.15] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Eswara JR, Lee H, Dretler SP, Sacco D. The effect of delayed percutaneous nephrolithotomy on the risk of bacteremia and sepsis in patients with neuromuscular disorders. World J Urol 2013; 31:1611-5. [DOI: 10.1007/s00345-013-1044-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 02/18/2013] [Indexed: 10/27/2022] Open
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Welk B, Fuller A, Razvi H, Denstedt J. Renal stone disease in spinal-cord-injured patients. J Endourol 2012; 26:954-9. [PMID: 22356464 DOI: 10.1089/end.2012.0063] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Renal stone disease is common among patients with spinal cord injury (SCI). They frequently have recurrent stones, staghorn calculi, and bilateral stone disease. The potential risk factors for stones in the SCI population are lesion level, bladder management strategy, specific metabolic changes, and frequent urinary tract infections. There has been a reduction in struvite stones among these patients, likely as a result of advances in their urologic care. The clinical presentation of stone disease in patients with SCI may involve frequent urinary infections or urosepsis, and at the time of presentation patients may need emergency renal drainage. The proportion of patients who have their stones treated with different modalities is largely unknown. Shockwave lithotripsy (SWL) is commonly used to manage stones in patients with SCI, and there have been reports of stone-free rates of 50% to 70%. The literature suggests that the morbidity associated with percutaneous nephrolithotomy in these patients is considerable. Ureteroscopy is a common modality used in the general population to treat patients with upper tract stone disease. Traditional limitations of this procedure in patients with SCI have likely been overcome with new flexible scopes; however, the medical literature has not specifically reported on its use among patients with SCI.
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Affiliation(s)
- Blayne Welk
- The University of Western Ontario, St Joseph's Health Care, London, Ontario, Canada.
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Aliprantis AO, Stolina M, Kostenuik PJ, Poliachik SL, Warner SE, Bain SD, Gross TS. Transient muscle paralysis degrades bone via rapid osteoclastogenesis. FASEB J 2011; 26:1110-8. [PMID: 22125315 DOI: 10.1096/fj.11-196642] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A unilateral injection of botulinum toxin A (BTxA) in the calf induces paralysis and profound loss of ipsalateral trabecular bone within days. However, the cellular mechanism underlying acute muscle paralysis-induced bone loss (MPIBL) is poorly understood. We hypothesized that MPIBL arises via rapid and extensive osteoclastogenesis. We performed a series of in vivo experiments to explore this thesis. First, we observed elevated levels of the proosteoclastogenic cytokine receptor activator for nuclear factor-κB ligand (RANKL) within the proximal tibia metaphysis at 7 d after muscle paralysis (+113%, P<0.02). Accordingly, osteoclast numbers were increased 122% compared with the contralateral limb at 5 d after paralysis (P=0.04) and MPIBL was completely blocked by treatment with human recombinant osteoprotegerin (hrOPG). Further, conditional deletion of nuclear factor of activated T-cells c1 (NFATc1), the master regulator of osteoclastogenesis, completely inhibited trabecular bone loss (-2.2±11.9%, P<0.01). All experiments included negative control assessments of contralateral limbs and/or within-animal pre- and postintervention imaging. In summary, transient muscle paralysis induced acute RANKL-mediated osteoclastogenesis resulting in profound local bone resorption. Elucidation of the pathways that initiate osteoclastogenesis after paralysis may identify novel targets to inhibit bone loss and prevent fractures.
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Affiliation(s)
- Antonios O Aliprantis
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Philippou P, Moraitis K, Masood J, Junaid I, Buchholz N. The management of bladder lithiasis in the modern era of endourology. Urology 2011; 79:980-6. [PMID: 22119259 DOI: 10.1016/j.urology.2011.09.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 09/03/2011] [Accepted: 09/11/2011] [Indexed: 11/30/2022]
Abstract
The recent evolution in the management of vesical lithiasis is a result of the major advancements of modern endourology. The ideal method for achieving stone clearance, however, remains an issue of debate and evidence-based recommendations are lacking. Contemporary literature focuses on management options, such as extracorporeal shockwave lithotripsy, transurethral, percutaneous and minimally-invasive surgery, as well as state-of-the-art energy sources. Issues of particular interest include the results of comparative studies, the management of lithiasis in the paediatric population and the recent challenge of the traditional dogma that dictated BPH surgery for the management of vesical lithiasis secondary to bladder outlet obstruction.
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Affiliation(s)
- Prodromos Philippou
- Endourology & Stone Services, Barts and The London NHS Trust, West Smithfield, London, UK
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Evidence-based management of upper tract urolithiasis in the spinal cord-injured patient. Spinal Cord 2011; 49:948-54. [DOI: 10.1038/sc.2011.50] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Biering-Sørensen T, Hansen RB, Biering-Sørensen F. Home aids and personal assistance 10-45 years after spinal cord injury. Spinal Cord 2008; 47:405-12. [PMID: 19002151 DOI: 10.1038/sc.2008.132] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Assessment of home aids, adaptations and personal assistance received after traumatic spinal cord injury (SCI). SETTING Clinic for Spinal Cord Injuries, Denmark. Uptake area, 2.5 million inhabitants. STUDY DESIGN AND METHODS Cross-sectional follow-up with retrospective data from medical files. MATERIALS Individuals with traumatic SCI before 1 January 1991, still in regular follow-up and with sufficient medical record. In all, 279 were included, and 236 answered the questionnaire (193 men and 43 women), with a response rate of 84.6%. Mean age at follow-up was 50.5 years, and mean follow-up time, 24.1 years. One hundred and twenty-six were paraplegic and 110, tetraplegic. Responders and non-responders were comparable. RESULTS Most common aids or adaptations reported were commode/shower chair on wheels or a seat (69%), grab bar by the toilet (41%), electrical bed (44%), special mattress (28%), lift/hoist (20%), computers (39%) and kitchen tools or cutlery with special handles (14%). In all, 7.6% of the participants reported no aids. Eighty-two percent answered 'Yes' to the question 'Have the aids, you currently or previously needed, been available to you?' The majority reported that their source of information about aid had been various journals and magazines. Twenty-one percent had personal helpers, with 60 h per week in median (range 2-168). Thirty-three percent received domestic help with 2.5 h per week in median (range 0.5-37). Eight percent had a home nurse. A total of 98.7% were living in their own homes. CONCLUSIONS This is the first study of a representative SCI population giving information on home aids. Individuals with SCI in Denmark seem to be sufficiently supplied with aids and personal assistance.
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Affiliation(s)
- T Biering-Sørensen
- Clinic for Spinal Cord Injuries, The NeuroScience Centre, Rigshospitalet, University of Copenhagen, Hornbaek, Denmark
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