Welk B et al, 2012: Renal Stone Disease in Spinal-Cord-Injured Patients
Welk B, Fuller A, Razvi H, Denstedt J
The University of Western Ontario, London, Ontario, Canada
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.
J Endourol. 2012 Aug;26(8):954-9. doi: 10.1089/end.2012.0063. Epub 2012 Apr 17
PMID: 22356464 [PubMed - as supplied by publisher]
This is a review of stone-formation and treatment in patients with spinal cord injuries. The important information is that urease-induced staghorn stones have decreased in frequency during recent years. The more commonly encountered stone component today is reported to be calcium apatite (stones probably composed of both hydroxyapatite and carbonate apatite).
The problem of stone clearance is discussed and the difficulties appreciated by the authors. Not mentioned in the article is the option of percutaneous chemolysis in combination with ESWL. It should be noted that Renacidin (hemiacidrin) as well as Suby’s solution can dissolve both magnesium ammonium phosphate and different calcium phosphates. In my hands that approach has proven very successful for this group of patients.