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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Conflict of interest
Dr. Amy Krambeck, HistoSonics, Consultant; Dr. Marisa M. Clifton, M.D.; Matthew T. Gettman, M.D.; David E. Patterson, M.D.; Laureano Rangel—No competing financial interests exist. All authors have no conflicts of interest.
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This study has been approved by the Mayo Clinic Institutional Review Board and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. This is a retrospective review and therefore informed consent could not feasibly be obtained from every patient. This study does not contain prospective clinical studies and all patients were deidentified prior to inclusion in our data set.
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Clifton, M.M., Gettman, M.T., Patterson, D.E. et al. The change in upper tract urolithiasis composition, surgical treatments and outcomes of para and quadriplegic patients over time. Urolithiasis 42, 415–419 (2014). https://doi.org/10.1007/s00240-014-0681-0
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DOI: https://doi.org/10.1007/s00240-014-0681-0