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Clifton MM et al, 2014: The change in upper tract urolithiasis composition, surgical treatments and outcomes of para and quadriplegic patients over time.

Clifton MM, Gettman MT, Patterson DE, Rangel L, Krambeck AE

Department of Urology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA.

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. 

Urolithiasis. 2014 Jul 12. [Epub ahead of print]

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Comments 1

Peter Alken on Tuesday, 02 December 2014 11:12

Patients with neurogenic disorders are prone to have complications of stone therapy. Unfortunately the experience is limited and 95 patients in 25 years are like an extended case report with a lot of variations in diagnostic and therapeutic procedures. There is no information about changing therapeutic trends in this patient group; like this it is difficult to tell if the reported outcomes of the different procedures reflect a learning effect or a wise selection or are just casual.

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Patients with neurogenic disorders are prone to have complications of stone therapy. Unfortunately the experience is limited and 95 patients in 25 years are like an extended case report with a lot of variations in diagnostic and therapeutic procedures. There is no information about changing therapeutic trends in this patient group; like this it is difficult to tell if the reported outcomes of the different procedures reflect a learning effect or a wise selection or are just casual. [img]http://storzmedical.com/images/blog/Clifton_MM.png[/img]
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